Yonsei Med J.  2007 Apr;48(2):157-163. 10.3349/ymj.2007.48.2.157.

Meta-Analysis: Some Clinical and Statistical Contributions in Several Medical Disciplines

• Bartolucci AA

• KMID: 1779515
• DOI: http://doi.org/10.3349/ymj.2007.48.2.157

Abstract

Meta-analysis in its present form of statistically integrating information from several studies all with a common underlying theme has been around for over 25 years. The medical field has seen many attempts by many investigators to pull summary data together from various sources within a discipline with the goal of making some definitive statement about the state of the science in that discipline. Likewise authors of manuscripts in the background and rationale section of their paper always summarize what they believe to be the state of affairs up to the time of the presentation of their own results in that particular paper. The new data and results they present in their current publication is an attempt to update the progress in that field. Thus in a sense they have performed a partial meta- analysis of summarizing information from the past, presenting their added contribution and thus updating the knowledge base. They have not quite integrated past data in a rigorous statistical way with their new data, but have merely used the data history to justify their current research which pretty much stands on its own. Thus meta-analysis is an after the fact attempt to pull together the current knowledge base whether it be publications or raw data and present a statistical synthesis of all the information and reach a conclusion as to the best treatment or intervention strategy based on all these past contributions. Now it's time to look back at some of these meta-analyses and determine what contributions, if any, they have made to the knowledge base within certain medical disciplines. Many disciplines including psychiatry have been visited by meta- analysis. One now examines some of these studies in the areas of oncology, orthopedics, psychiatry, pediatrics and cardiology. The purpose is to determine, given the information presented, what contributions, statistical challenges and peripheral issues in these disciplines have been brought to light in these meta- analyses.

Keyword

Meta-analysis; statistical homogeneity; clinical trials; summary statistics; relative risk; odds ratio; effect size

Reference

1. Bartolucci A. The significance of clinical trials and the role of meta-analysis. J Surg Oncol. 1999. 72:121–123.

2. Bartolucci AA, Katholi CR, Singh KP, Alarcon GS. Issues in meta-analysis: an overview. Arthritis Care Res. 1994. 7:156–160.

3. Mosteller F, Chalmers C. Some progress and problems in meta-analysis of clinical trials. Stat Sci. 1992. 7:227–236.

4. Dickersin K, Berlin JA. Meta-analysis: state of the science. Epidemiol Rev. 1992. 14:154–176.

5. Counsell C. Formulating questions and locating primary studies for inclusion in systematic reviews. Ann Intern Med. 1997. 127:380–387.

6. Early Breast Cancer Trialists' Collaborative Group. Tamoxifen for early breast cancer: an overview of the randomized trials. Lancet. 1998. 351:1451–1467.

7. Early Breast Cancer Trialists' Collaborative Group. Effects of adjuvant tamoxifen and of cytotoxic therapy on mortality in early breast cancer. An overview of 61 randomised trials among 28,896 women. N Engl J Med. 1988. 319:1681–1692.

8. Early Breast Cancer Trialists' Collaborative Group. Treatment of early breast cancer, vol 1: worldwide evidence 1985-1990. 1990. 1. Oxford: Oxford University Press.

9. Early Breast Cancer Trialists' Collaborative Group. Systemic treatment of early breast cancer by hormonal, cytotoxic, or immune therapy. 133 randomised trials involving 31 000 recurrences and 24,000 deaths among 75,000 women. Lancet. 1992. 339:71–85.

10. Early Breast Cancer Trialists' Collaborative Group. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. N Engl J Med. 1995. 333:1444–1455.

11. Early Breast Cancer Trialists' Collaborative Group. Ovarian ablation in early breast cancer: overview of the randomised trials. Lancet. 1996. 348:1189–1196.

12. Bjordal JM, Klovning A, Ljunggren AE, Slordal L. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials. Eur J Pain. 2007. 11:125–138.

13. In-Albon T, Schneider S. Psychotherapy of childhood anxiety disorders: A meta-analysis. Psychother Psychosom. 2007. 76:15–24.

14. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005. 162:214–227.

15. Kerren R, Chan E. A meta-analysis of randomized controlled trials comparing short- and long-course antibiotic therapy for urinary tract infections in children. Pediatrics. 2002. 109:E70.

16. Bartolucci AA, Howard G. Meta-analysis of data from the six primary prevention trials of cardiovascular events using aspirin. Am J Cardiol. 2006. 98:746–750.

17. Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano JM, Manson JE, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med. 2005. 352:1293–1304.

18. Final report on the aspirin component of the ongoing Physicians' Health Study. Steering Committee of the Physicians' Health Study Research Group. N Engl J Med. 1989. 321:129–135.

19. Peto R, Gray R, Collins R, Wheatley K, Hennekens C, Jamrozik K, et al. Randomised trial of prophylactic daily aspirin in British male doctors. British medical journal (Clinical research ed.). 1988. 296:313–316.

20. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998. 351:1755–1762.

21. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Collaborative Group of the Primary Prevention Project. Lancet. 2001. 357:89–95.

22. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. The Medical Research Council's General Practice Research Framework. Lancet. 1998. 351:233–241.

23. Bartolucci A. The significance of clinical trials and the role of meta-analyses. J Surg Oncol. 1999. 72:121–123.