Abstract
The aim of this work was to examine the burden of further treatments in patients with colorectal cancer following a decision about lung metastasectomy. 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. 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. 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.
Highlights
From the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study the following 98 results have been reported: survival in the full cohort of 512 patients[1]comparative survival, quality of life and health utility in the randomised controlled trial nested within it.[2,3,4]The PulMiCC RCT in 93 patients showed no difference in survival at any time point but the analysis cannot exclude some survival benefit from metastasectomy in the long term[2]
249/250 words 61 62 Aim We wanted to examine the burden of further treatments in patients with colorectal cancer (CRC) following a decision concerning lung metastasectomy. 66 Methods Five teams participating in the study of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) provided details on all subsequent local treatments for lung metastases and of the use of systemic chemotherapy in patients with pulmonary metastatic disease
For patients in three groups, baseline factors and selection criteria for additional treatments were examined. 73 Results 74 220 patients were recruited between October 2010 and January 2017
Summary
From the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study the following 98 results have been reported: survival in the full cohort of 512 patients[1]. The PulMiCC RCT in 93 patients showed no difference in survival at any time point but the analysis cannot exclude some survival benefit from metastasectomy in the long term[2]. There are recently published data on the rate of lung metastasectomy operations colorectal cancer in the English National Health Service. If all lung resection were for CRC lung metastasis that would be the upper bound on the rate of lung metastasectomy[5] so it has not been commonly performed but is increasing. Of note is the recently published finding of no difference in survival in an analysis of Surveillance, Epidemiology and End Results (SEER) database associated with lung metastasectomy[6]
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