The Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) burden of care study: Analysis of local treatments for lung metastases and systemic chemotherapy in 220 patients in the PulMiCC cohort

被引：13

作者：

Treasure, Tom ^{[1
]}

Farewell, Vern ^{[2
]}

Macbeth, Fergus ^{[3
]}

Batchelor, Tim ^{[4
]}

Milosevic, Misel ^{[5
]}

King, Juliet ^{[6
]}

Zheng, Yan ^{[7
]}

Leonard, Pauline ^{[8
]}

Williams, Norman R. ^{[9
]}

Brew-Graves, Chris ^{[10
]}

Morris, Eva ^{[11
]}

Fallowfield, Lesley ^{[12
]}

机构：

[1] UCL, Clin Operat Res Unit, London WC1H 0BW, England

[2] MRC Biostat Unit, Cambridge, England

[3] Cardiff Univ, Ctr Trials Res, Cardiff, Wales

[4] Univ Hosp, Bristol Royal Infirm, Bristol, Avon, England

[5] Inst Lung Dis Vojvodina, Thorac Surg Clin, Sremska Kamenica, Serbia

[6] Guys & St Thomas Hosp, London, England

[7] Zheng Zhou Univ, Dept Thorac Surg, Affiliated Canc Hosp, Henan Canc Hosp, Zhengzhou, Henan, Peoples R China

[8] Barking Havering & Redbridge Univ Hosp, Romford, Essex, England

[9] UCL, Surg & Intervent Trials Unit SITU, London, England

[10] UCL, Div Med, Natl Canc Imaging Accelerator NCIA, London, England

[11] Big Data Inst, Oxford, England

[12] Univ Sussex, Sussex Hlth Outcomes Res & Educ Canc SHORE C, Falmer, England

来源：

COLORECTAL DISEASE | 2021年 / 23卷 / 11期

关键词：

burden of care; chemotherapy; colorectal cancer; pulmonary metastasectomy; SURVIVAL; OUTCOMES; SURGERY; MODELS; LIFE;

D O I：

10.1111/codi.15833

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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.

引用

页码：2911 / 2922

页数：12

共 27 条

[1]

[Anonymous], NATL BOWEL CANC AUDI

[2] Pulmonary metastasectomy in colorectal cancer: health utility scores by EQ-5D-3L in a randomized controlled trial show no benefit from lung metastasectomy [J].