Disagreements on study inclusion or data extraction were resolved by consensus https://www.selleckchem.com/products/apr-246-prima-1met.html of all coauthors. The outcome measures extracted were: objective tumor response, improved or stabilized performance status, and severe CP673451 nmr chemotherapy toxicity. Statistical analysis Meta-analysis was done with Review Manager 4.2 (The Cochrane Collaboration,

Oxford, UK) [11]. Relative ratio (RR) and 95% confidence intervals (CI) were calculated, hypothesis of homogeneity was not rejected, the fixed-effects model was used to calculate the summary relative ratio (RR), and the 95% CI. Otherwise, a random-effects model was used [14]. In this meta-analysis, three kind of following outcomes were calculated and analyzed appropriately. 1. Objective tumor response The rate of tumor response was calculated as the number of patients experiencing complete response and partial response divided by the total number of patients (complete response plus partial response plus no change plus progressive disease) in each group, The RR of tumor response was calculated

as the rate of tumor response in the SFI combined with platinum-based chemotherapy treatment group divided by that in the platinum-based chemotherapy GSK2126458 clinical trial control group. Thus, a RR of more than 1 favors the SFI combined with platinum-based chemotherapy treatment group. This method has been recommended by Sutton et al [15]. 2. Improved or stable performance status This is similar to the approach of Michael et al [5]. The rate of improved or stable performance status was calculated as the proportion of improved or stable performance status (>10-point increase plus no change) divided by the total (>10-point increase, plus no change, plus >10-point decrease). The RR of improved or stable performance status was analyzed as the rate of improved or stable performance status in the SFI combined with platinum-based chemotherapy treatment group, divided by this proportion in the platinum-based chemotherapy control group. Thus, a RR of more than 1 favors the SFI combined with platinum-based chemotherapy treatment

group. 3. Severe chemotherapy toxicity Temsirolimus in vivo Using the approach of Delbaldo et al [16], the rate of severe chemotherapy toxicity was defined as the number of patients experiencing severe toxicity (WHO grades 3 and 4) divided by the total number of patients (WHO grades 0, 1, 2, 3 and 4) in each group. The RR of severe chemotherapy toxicity was analyzed as the proportion of severe toxicity in the SFI combined with platinum-based chemotherapy treatment group divided by this proportion in the platinum-based chemotherapy control group. Thus, a RR of less than 1 favors the SFI combined with platinum-based chemotherapy treatment group. Study quality evaluation Two reviewers (Ju Dong, Shi-Yue Su) independently graded each RCT/CCT using the modified Jadad scale[17].