Pulmonary metastasectomy in colorectal cancer: health utility scores by EQ‐5D‐3L in a randomized controlled trial show no benefit from lung metastasectomy

Abstract

Aim The aim was to assess the health utility of lung metastasectomy in the treatment of patients with colorectal cancer (CRC) using the EQ‐5D‐3L questionnaire. Methods Multidisciplinary CRC teams at 14 sites recruited patients to a two‐arm randomized controlled trial—Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC). Remote randomization was used, stratified by site and with minimization for seven known confounders. Participants completed the EQ‐5D‐3L questionnaire together with other patient reported outcome measures at randomization and then again at 3, 6, 12 and 24 months. These were returned by post to the coordinating centre. Results Between December 2010 and December 2016, 93 participants were randomized, 91 of whom returned questionnaires. Survival and patient reported quality of life have been published previously, revealing no significant differences between the trial arms. Described here are patient reported data from the five dimensions of the EQ‐5D‐3L and the visual analogue scale (VAS) health state. No significant difference was seen at any time point. The estimated difference between control and metastasectomy patients was −0.23 (95% CI –0.113, 0.066) for the composite 0 to 1 index scale based on the descriptive system and 0.123 (95% CI –7.24, 7.49) for the 0 to 100 VAS scale. Conclusions Following lung metastasectomy for CRC, no benefit was demonstrated for health utility, which alongside a lack of a survival or quality of life benefit calls into question the widespread use of the procedure.

National variation in pulmonary metastasectomy for colorectal cancer

“…Current NICE draft guidance [7] suggests that there is insufficient evidence to recommend one type of local treatment over another so either surgical resection, ablation or SBRT should be considered for people with colorectal lung metastases. It will be interesting to note whether trusts with lower resection rates refer larger numbers of patients for ablation or SBRT and whether patients have similar access to all treatments across trusts.…”

Lung metastasectomy for colorectal cancer: The impression of benefit from uncontrolled studies was not supported in a randomized controlled trial

“…6 The Health Utility instrument EuroQol 5 dimensions, 3 levels, showed similar losses in self-reported health status during the first 2 years after randomization (Figure 3). 10 At a sample size of 93, PulMiCC is large enough to draw some important conclusions about the true effect on survival. If the zero assumption was correct, the results should have been 0 out of 47 control survival versus 17 out of 46 (37%) among randomly assigned patients (Fisher exact test P < .0001).…”

Surgery, selection or biology in lung metastasectomy for colorectal lung metastasectomy? PulMiCC may not provide all the answers but it does narrow down the question

“…The authors kindly mentioned the randomised controlled trial (RCT) Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) citing a preliminary analysis [2]. There was no difference in quality of life or health utility [3]. The full randomised trial (N=93) has since been published [4].…”