Background
Methods
Search strategy
Eligibility criteria
Study identification
Data extraction
Analysis
Characteristics of included studies
Reporting of methodological attributes associated with clinical significance
Clinical significance
Statistical analysis
Results
Characteristic | Non-inferiority trials (N = 11) | Superiority trials (N = 66) | ||
---|---|---|---|---|
n
| % |
n
| % | |
Journal of publication | ||||
Journal of Clinical Oncology | 3 | 27.3 | 25 | 37.9 |
Blood | 2 | 18.2 | 10 | 15.2 |
Pediatric Blood & Cancer | 0 | 0.0 | 6 | 9.1 |
Leukemia | 1 | 9.1 | 4 | 6.1 |
Lancet | 2 | 18.2 | 1 | 1.5 |
Cancer | 0 | 0.0 | 4 | 6.1 |
Lancet Oncology | 1 | 9.1 | 3 | 4.5 |
New England Journal of Medicine | 1 | 9.1 | 2 | 3 |
Other | 1 | 9.1 | 11 | 16.7 |
Region of publication | ||||
Europe | 6 | 54.5 | 23 | 34.8 |
North America | 4 | 36.4 | 41 | 62.1 |
Other | 1 | 9.1 | 2 | 3 |
Year of publication | ||||
1976 to 1989 | 1 | 9.1 | 4 | 6.1 |
1990 to 2003 | 4 | 36.4 | 28 | 42.4 |
2004 to 2016 | 6 | 54.5 | 34 | 51.5 |
Source of funding | ||||
Non-industry | 10 | 90.9 | 56 | 84.8 |
Industry and non-industry | 0 | 0.0 | 2 | 3 |
Not stated | 1 | 9.1 | 8 | 12.1 |
Study participants | ||||
Exclusively children | 7 | 63.6 | 41 | 62.1 |
Adults included | 4 | 36.4 | 25 | 37.9 |
Disease site | ||||
Hematological | 7 | 63.6 | 43 | 65.2 |
Central nervous system tumor | 1 | 9.1 | 11 | 16.7 |
Non-central nervous system solid tumor | 3 | 27.3 | 12 | 18.2 |
RCT study design | ||||
2 × 2 factorial | 0 | 0.0 | 4 | 6.1 |
Greater than 2 arms | 1 | 9.1 | 5 | 7.6 |
Two-armed | 10 | 90.9 | 57 | 86.3 |
RCT trial group | ||||
POG | 1 | 9.1 | 15 | 22.7 |
CCG | 1 | 9.1 | 12 | 18.2 |
COG | 0 | 0.0 | 8 | 12.1 |
BFM | 1 | 9.1 | 9 | 13.6 |
UK MRC | 1 | 9.1 | 4 | 6.1 |
Other | 7 | 63.6 | 18 | 27.3 |
Outcome | ||||
Time-to-event | 10 | 90.9 | 56 | 84.8 |
Dichotomous | 1 | 9.1 | 10 | 15.2 |
Intervention in question | ||||
Chemotherapy | 9 | 81.8 | 57 | 86.4 |
Multimodal therapy | 0 | 0.0 | 2 | 3 |
Hemopoietic stem-cell transplant | 1 | 9.1 | 6 | 9.1 |
Radiation therapy | 1 | 9.1 | 1 | 1.5 |
Characteristic | Non-inferiority trials (N = 13) | Superiority trials (N = 82) | ||
---|---|---|---|---|
n
| %b |
n
| %b | |
Methods | ||||
Expected magnitude of difference identified explicitly as the MCIDc | 2 | 15.4 | 2 | 2.4 |
Justification for MCIDa | ||||
Clinical relevance | 1 | 50.0 | 1 | 50.0 |
Methodological | 1 | 50.0 | 1 | 50.0 |
Delta value | ||||
Stated as an absolute difference | 13 | 100.0 | 78 | 95.1 |
Margin (median, IQR) | − 0.10 | − 0.10,0.10 | 0.12 | 0.10, 0.17 |
Time-to-event | 12 | 92.3 | 69 | 88.5 |
Dichotomous outcome | 1 | 7.7 | 9 | 11.5 |
Stated as relative difference | 0 | 0.0 | 7 | 8.5 |
Margin (median, IQR) | N/A | 0.63 | 0.60, 2.50 | |
Time-to-event | N/A | 6 | 85.7 | |
Dichotomous outcome | N/A | 1 | 14.3 | |
Stated as a percentage and ratio | 0 | 0.0 | 4 | 4.9 |
Anticipated control value stated | 10 | 76.9 | 63 | 76.8 |
Assumptions in the control group | 6 | 46.2 | 12 | 14.6 |
Stated | ||||
Results from previous trial or systematic review | 5 | 83.3 | 11 | 91.7 |
Based on clinical expertise | 1 | 16.7 | 1 | 8.3 |
Type 1 error (α value) | ||||
Stated | 10 | 76.9 | 52 | 63.4 |
0.20 | 0 | 0.0 | 1 | 1.9 |
0.10 | 2 | 20.0 | 2 | 3.8 |
0.05 | 8 | 80.0 | 49 | 94.2 |
Sides | ||||
Stated | 12 | 92.3 | 40 | 48.8 |
One-sided | 10 | 83.3 | 29 | 72.5 |
Two-sided | 2 | 16.7 | 11 | 27.5 |
Type 2 error (1 − β value) | ||||
Stated | 12 | 92.3 | 81 | 98.8 |
< 80% | 2 | 16.7 | 7 | 8.6 |
80 to 85% | 6 | 50.0 | 58 | 71.6 |
85 to 90% | 1 | 8.3 | 7 | 8.6 |
≥ 90% | 3 | 25.0 | 9 | 11.1 |
Results | ||||
Statistical significance of primary outcome reported via p value | 13 | 100.0 | 66 | 80.5 |
Confidence intervals/standard error for primary outcome reported | 12 | 92.3 | 52 | 63.4 |
Treatment effect stated | 6 | 46.2 | 6 | 7.3 |
Discussion (and/or Results) | ||||
Clinical importance of primary outcome discussed | 10 | 76.9 | 11 | 13.4 |
Clinical significance | Statistical significance | Total N = 71 | ||||
---|---|---|---|---|---|---|
No (n = 47) | Yes (n = 24) | |||||
N
| % |
N
| % |
N
| % | |
Definite | 0 | 0.0 | 2 | 8.3 | 2 | 2.8 |
Probable | 0 | 0.0 | 7 | 29.2 | 7 | 9.9 |
Possible | 12a | 25.5 | 13 | 54.2 | 25 | 35.2 |
Definitely Not | 35 | 74.5 | 2b | 8.3 | 37 | 52.1 |
Discussion
Strengths and weaknesses
Comparison with existing literature
Study explanations and implications
Recommendations
Recommendationsa | |
---|---|
1. Conduct a comprehensive review of the literature to identify the MCID. If the RCT is completely novel, use preliminary pilot data to inform the MCID | |
2. Perform a sample size calculation using a delta value that is based on the MCID. If the sample size is not feasible given resource constraints, adjust the delta value to increase the sample size to a value that is still clinically meaningful | |
3. When reporting the results of an RCT ensure the following are reported in the sample size calculation: • Type 1 error (α value) ○ One- or two-sided p value • Type 2 error (β value) ○ At least 80% is recommended • Estimated controlled value and justification • Estimated experimental value and justification • Delta value in absolute terms and justification of treatment effect • Explicitly identify primary outcome when multiple outcomes are being investigated | |
4. Calculate and report confidence intervals for the experimental and controlled values as well as the treatment effect | |
5. Interpret the treatment effect and its confidence interval in relation to the MCID and place weight on conclusions based on the precision determined by the confidence interval | |
6. Ensure conclusions reflect the quality of the trial based on the recommendations of the CONSORT Statement |