Tom Treasure1, Vern Farewell2, Fergus Macbeth3, Tim Batchelor4, Misel Milosevic5, Juliet King6, Yan Zheng7, Pauline Leonard8, Norman R Williams9, Chris Brew-Graves10, Eva Morris11, Lesley Fallowfield12. 1. Clinical Operational Research Unit, University College London, London, UK. 2. MRC Biostatistics Unit, Cambridge, UK. 3. Centre for Trials Research, Cardiff University, Cardiff, UK. 4. Bristol Royal Infirmary, University Hospitals, Bristol, UK. 5. Institute for Lung Diseases of Vojvodina, Thoracic Surgery Clinic, Sremska Kamenica, Serbia. 6. Guy's and St Thomas' Hospital, London, UK. 7. Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zheng Zhou University/Henan Cancer Hospital, Zheng Zhou, Henan Province, China. 8. Barking, Havering and Redbridge University Hospitals, Romford, UK. 9. Surgical and Interventional Trials Unit (SITU), University College London, London, UK. 10. Division of Medicine, National Cancer Imaging Accelerator (NCIA), University College London, London, UK. 11. Big Data Institute, Oxford, UK. 12. Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Falmer, UK.
Abstract
AIM: The aim of this work was to examine the burden of further treatments in patients with colorectal cancer following a decision about lung metastasectomy. METHOD: Five teams participating in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study provided details on subsequent local treatments for lung metastases, including the use of chemotherapy. For patients in three groups (no metastasectomy, one metastasectomy or multiple local interventions), baseline factors and selection criteria for additional treatments were examined. RESULTS: The five teams recruited 220 patients between October 2010 and January 2017. No lung metastasectomy was performed in 51 patients, 114 patients had one metastasectomy and 55 patients had multiple local interventions. Selection for initial metastasectomy was associated with nonelevated carcinoembryonic antigen, fewer metastases and no prior liver metastasectomy. These patients also had better Eastern Cooperative Oncology Group scores and lung function at baseline. Four sites provided information on chemotherapy in 139 patients: 79 (57%) had one to five courses of chemotherapy, to a total of 179 courses. The patterns of survival after one or multiple metastasectomy interventions showed evidence of guarantee-time bias contributing to an impression of benefit over no metastasectomy. After repeated metastasectomy, a significantly higher risk of death was observed, with no apparent reduction in chemotherapy usage. CONCLUSION: Repeated metastasectomy is associated with a higher risk of death without reducing the use of chemotherapy. Continued monitoring without surgery might reassure patients with indolent disease or allow response assessment during systemic treatment. Overall, the carefully collected information from the PulMICC study provides no indication of an important survival benefit from metastasectomy.
AIM: The aim of this work was to examine the burden of further treatments in patients with colorectal cancer following a decision about lung metastasectomy. METHOD: Five teams participating in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study provided details on subsequent local treatments for lung metastases, including the use of chemotherapy. For patients in three groups (no metastasectomy, one metastasectomy or multiple local interventions), baseline factors and selection criteria for additional treatments were examined. RESULTS: The five teams recruited 220 patients between October 2010 and January 2017. No lung metastasectomy was performed in 51 patients, 114 patients had one metastasectomy and 55 patients had multiple local interventions. Selection for initial metastasectomy was associated with nonelevated carcinoembryonic antigen, fewer metastases and no prior liver metastasectomy. These patients also had better Eastern Cooperative Oncology Group scores and lung function at baseline. Four sites provided information on chemotherapy in 139 patients: 79 (57%) had one to five courses of chemotherapy, to a total of 179 courses. The patterns of survival after one or multiple metastasectomy interventions showed evidence of guarantee-time bias contributing to an impression of benefit over no metastasectomy. After repeated metastasectomy, a significantly higher risk of death was observed, with no apparent reduction in chemotherapy usage. CONCLUSION: Repeated metastasectomy is associated with a higher risk of death without reducing the use of chemotherapy. Continued monitoring without surgery might reassure patients with indolent disease or allow response assessment during systemic treatment. Overall, the carefully collected information from the PulMICC study provides no indication of an important survival benefit from metastasectomy.
Authors: Soohyeon Lee; Young Soo Park; Jwa Hoon Kim; Ah Reum Lim; Myung Han Hyun; Boyeon Kim; Jong Won Lee; Saet Byeol Lee; Yeul Hong Kim Journal: Cancers (Basel) Date: 2022-09-28 Impact factor: 6.575