1
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Macbeth F, Williams N, Ahmad I, Treasure T. Lung surveillance following colorectal cancer pulmonary metastasectomy: Utilization of clinicopathologic risk factors to guide strategy. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00990-X. [PMID: 37952137 DOI: 10.1016/j.jtcvs.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Norman Williams
- Surgical and Interventional Trials Unit, University College London, London, United Kingdom
| | - Irfan Ahmad
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom
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Macbeth F, Fallowfield L, Treasure E, Ahmad I, Zheng Y, Treasure T. Removal or ablation of asymptomatic lung metastases should be reconsidered. BMJ 2023; 383:e073042. [PMID: 37945005 DOI: 10.1136/bmj-2022-073042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, University of Sussex, Sussex, UK
| | - Elizabeth Treasure
- Patient author, Oxford University Counselling Service, University of Oxford, Oxford, UK
| | - Irfan Ahmad
- Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Yan Zheng
- Department of Thoracic Surgery, Affiliated Cancer Hospital of ZhengZhou University/Henan Cancer Hospital, People's Republic of China
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Macbeth F, Treasure T. Local Treatments of Oligometastatic and Oligoprogressive NSCLC Should Not Become the Standard of Care. J Thorac Oncol 2023; 18:981-985. [PMID: 37479328 DOI: 10.1016/j.jtho.2022.09.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 07/23/2023]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom.
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Treasure T, Macbeth F, Williams NR. Letter to the editor in response to Andreas Gkikas et al: Preoperative prognostic factors for 5-year survival following pulmonary metastasectomy from colorectal cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2023:7179794. [PMID: 37228033 DOI: 10.1093/ejcts/ezad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/24/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
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Treasure T, Macbeth F. Finding that outcomes after imaging-guided thermal ablation and surgery for colorectal lung metastases are similar does not prove a survival benefit from either. J Surg Oncol 2023; 127:510-512. [PMID: 36394433 DOI: 10.1002/jso.27145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Tom Treasure
- Department of Mathematics, Clinical Operational Research Unit, University College London, London, UK
| | - Fergus Macbeth
- Center for Trials Research, Cardiff University, Cardiff, UK
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Macbeth F, Williams NR, Treasure T. Comment on: A Systematic Review and Meta-analysis of Patient Survival and Disease Recurrence Following Percutaneous Ablation of Pulmonary Metastasis. Cardiovasc Intervent Radiol 2022; 45:1114-1116. [DOI: 10.1007/s00270-022-03172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/02/2022]
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7
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Treasure T, Williams NR, Macbeth F. The cohort data in the full pulmonary metastasectomy in colorectal cancer study: Comment on Engstrand et al. Eur J Surg Oncol 2022; 48:1869-1870. [PMID: 35525726 DOI: 10.1016/j.ejso.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, UK.
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardif University, Cardiff, UK
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Macbeth F, Treasure T, Williams NR. Letter in Response to 'Approach to Oligometastatic Cancer in the Elderly Patient'. Curr Oncol Rep 2022; 24:1091-1093. [PMID: 35451687 DOI: 10.1007/s11912-022-01236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
| | - Norman R Williams
- Surgical and Interventional Trial Unit, University College London, London, UK
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Treasure T, Macbeth F, Younes R. The Pulmonary Metastasectomy in Colorectal Cancer study calls for reconsideration of the clinical effectiveness of this widespread practice. Rev Assoc Med Bras (1992) 2022; 68:296-298. [PMID: 35442350 DOI: 10.1590/1806-9282.20211094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Tom Treasure
- University College London, Clinical Operational Research Unit - London, United Kingdom
| | - Fergus Macbeth
- Cardiff University, Centre for Trials Research - Cardiff, United Kingdom
| | - Riad Younes
- Hospital Alemão Oswaldo Cruz, Cancer Center - São Paulo (SP), Brazil
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Williams NR, Patrick H, Fiorentino F, Allen A, Sharma M, Milošević M, Macbeth F, Treasure T. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) randomised controlled trial: a systematic review of published responses. Eur J Cardiothorac Surg 2022; 62:6567629. [PMID: 35415756 PMCID: PMC9257793 DOI: 10.1093/ejcts/ezac253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/15/2022] [Accepted: 04/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this review was to assess the nature and tone of the published responses to the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) randomized controlled trial. METHODS Published articles that cited the PulMiCC trial were identified from Clarivate Web of Science (©. Duplicates and self-citations were excluded and relevant text extracted. Four independent researchers rated the extracts independently using agreed scales for the representativeness of trial data and the textual tone. The ratings were aggregated and summarized. Two PulMiCC authors carried out a thematic analysis of the extracts. RESULTS Sixty-four citations were identified and relevant text was extracted and examined. The consensus rating for data inclusion was a median of 0.25 out of 6 (range 0 to 5.25, IQR 0-1.5) and for textual tone the median rating was 1.87 out of 6 (range 0 to 5.75, IQR 1-3.5). The majority of citations did not provide adequate representation of the PulMiCC data and the overall the textual tone was dismissive. Although some were supportive, many discounted the findings because the trial closed early and was underpowered to show non-inferiority. Two misinterpreted the authors' conclusions but there was acceptance that five-year survival was much higher than widely assumed. CONCLUSIONS Published comments reveal a widespread reluctance to consider seriously the results of a carefully conducted randomized trial. This may be because the results challenge accepted practice because of 'motivated reasoning'. But there is a widespread misunderstanding of the fact that though PulMiCC with 93 patients was underpowered to test non-inferiority, it still provides reliable evidence to undermine the widespread belief in a major survival benefit from metastasectomy.
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Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | | | - Francesca Fiorentino
- Nightingale-Saunders Clinical Trials & Epidemiology Unit, King's Clinical Trials Unit, Kings College London, UK
| | | | - Manuj Sharma
- Research Department of Primary Care and Population Health, University College, London, UK
| | - Mišel Milošević
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | | | - Tom Treasure
- Clinical Operational Research Unit, University College London, UK
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11
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Moleman M, Macbeth F, Wieringa S, Forland F, Shaw B, Zuiderent-Jerak T. From "getting things right" to "getting things right now": Developing COVID-19 guidance under time pressure and knowledge uncertainty. J Eval Clin Pract 2022; 28:49-56. [PMID: 34617367 PMCID: PMC8657322 DOI: 10.1111/jep.13625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 09/07/2021] [Accepted: 09/12/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND At the start of the COVID-19 pandemic, guidance was needed more than ever to direct frontline healthcare and national containment strategies. Rigorous guidance based on robust research was compromised by the emergence of the pandemic and the urgency of need for guidance. Rather than aiming to "get guidance right", guidance developers needed to "get guidance right now". AIM To examine how guidance developers have responded to the need for credible guidance at the start of the COVID-19 pandemic. METHODS An exploratory mixed-methods study was conducted among guidance developers. A web-based survey and follow-up interviews were used to examine the most pertinent challenges in developing COVID-19 guidance, strategies used to address these, and perspectives on the implications of the COVID-19 pandemic on future guidance development. RESULTS The survey was completed by 46 guidance developers. Survey findings showed that conventional methods of guidance development were largely unsuited for COVID-19 guidance, with 80% (n = 37) of respondents resorting to other methods. From the survey and five follow-up interviews, two themes were identified to bolster the credibility of guidance in a setting of extreme uncertainty: (1) strengthening end-user involvement and (2) conjoining evidence review and recommendation formulation. 70% (n = 32) of survey respondents foresaw possible changes in future guidance production, most notably shortening development time, by reconsidering how to balance between rigour and speed for different types of questions. CONCLUSION "Getting guidance right" and "getting guidance right now" are not opposites, rather uncertainties are always part of guidance development and require guidance developers to balance scientific robustness with usability, acceptability, adequacy and contingency. This crisis points to the need to acknowledge uncertainties of scientific evidence more explicitly and points to mechanisms to live with such uncertainty, thus extending guidance development methods and processes more widely.
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Affiliation(s)
- Marjolein Moleman
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Sietse Wieringa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Frode Forland
- Division for Infectious Diseases and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Institute for Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Beth Shaw
- Oregon Health & Science University, Portland, Oregon, USA
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Treasure T, Dunning J, Williams NR, Macbeth F. Lung metastasectomy for colorectal cancer: The impression of benefit from uncontrolled studies was not supported in a randomized controlled trial. J Thorac Cardiovasc Surg 2022; 163:486-490. [PMID: 33840470 DOI: 10.1016/j.jtcvs.2021.01.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/19/2020] [Accepted: 01/02/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom.
| | - Joel Dunning
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, United Kingdom
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
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Macbeth F, Williams N, Treasure T. Stereotactic radiotherapy needs more evidence before it can be used routinely to treat metastases: a comment on the paper by Nicosia et al. Radiother Oncol 2022; 169:159-160. [DOI: 10.1016/j.radonc.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
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14
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Macbeth F, Treasure T. Stereotactic Ablative Radiotherapy for Oligometastatic Disease: Great Enthusiasm but Scant Evidence. Clin Oncol (R Coll Radiol) 2022; 34:313-317. [DOI: 10.1016/j.clon.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 12/25/2022]
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Treasure T, Williams NR, Macbeth F. The full cohort of 512 patients and the nested controlled trial in 93 patients in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study raise doubts about the effective size at present claimed. J Cardiothorac Surg 2022; 17:9. [PMID: 35034630 PMCID: PMC8762936 DOI: 10.1186/s13019-022-01757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/08/2022] [Indexed: 11/23/2022] Open
Abstract
A comparison of the relative merits of video-assisted pulmonary metastasectomy versus thoracotomy is predicated on the assumption that removal of asymptomatic lung metastases favourably influences survival and that it does so by a large degree. Recently published but long-awaited evidence from a prospective cohort study and a randomised trial of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) challenges that assumption.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Macbeth F. PulMiCC was Not ‘Unsuccessful’ and Stereotactic Ablative Body Radiotherapy is Not Like a Parachute: Comments on the Editorial by Ostler et al. Clin Oncol (R Coll Radiol) 2022; 34:e139. [DOI: 10.1016/j.clon.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022]
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17
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Williams NR, Macbeth F, Treasure T. Colorectal cancer-related pulmonary metastasectomy: Factors affecting survival time. Thorac Cancer 2021; 13:517-518. [PMID: 34951126 DOI: 10.1111/1759-7714.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Professor of Cardiothoracic Surgery, Clinical Operational Research Unit, University College London, London, UK
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Macbeth F, Dunning J, Treasure T. Pulmonary metastasectomy in colorectal cancer: A letter in response to Antonoff and colleagues. JTCVS Open 2021; 8:612-613. [PMID: 36004202 PMCID: PMC9390400 DOI: 10.1016/j.xjon.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Macbeth F, Webster A. Erratum: Understanding bias in the medical literature: With reflections on metastasectomy. South African Journal of Oncology 2021. [DOI: 10.4102/sajo.v5i0.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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20
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Treasure T, Farewell V, Macbeth F, Batchelor T, Milosevic M, King J, Zheng Y, Leonard P, Williams NR, Brew-Graves C, Morris E, Fallowfield L. 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. Colorectal Dis 2021; 23:2911-2922. [PMID: 34310835 DOI: 10.1111/codi.15833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023]
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.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | | | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tim Batchelor
- Bristol Royal Infirmary, University Hospitals, Bristol, UK
| | - Misel Milosevic
- Institute for Lung Diseases of Vojvodina, Thoracic Surgery Clinic, Sremska Kamenica, Serbia
| | | | - Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zheng Zhou University/Henan Cancer Hospital, Zheng Zhou, Henan Province, China
| | - Pauline Leonard
- Barking, Havering and Redbridge University Hospitals, Romford, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, UK
| | - Chris Brew-Graves
- Division of Medicine, National Cancer Imaging Accelerator (NCIA), University College London, London, UK
| | | | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Falmer, UK
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Williams NR, Treasure T, Macbeth F, Fallowfield L. The Prospective Observational Cohort and the Nested Randomized Controlled Trial in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC Study) Question the Reliance on Existing Evidence for the Magnitude of Benefit From Lung Metastasectomy. Am J Clin Oncol 2021; 44:502-503. [PMID: 34432668 PMCID: PMC7611601 DOI: 10.1097/coc.0000000000000847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, UK
| | | | - Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Sussex, UK
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22
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Macbeth F, Treasure T. Early repeat resection of liver metastases from colorectal cancer may not be justified without controlled trial evidence. Cancer Epidemiol 2021; 74:101981. [PMID: 34272195 DOI: 10.1016/j.canep.2021.101981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, UK.
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23
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Van Raemdonck D, Treasure T, Van Cutsem E, Macbeth F. Pulmonary Metastasectomy in Colorectal Cancer: has the randomized controlled trial brought enough reliable evidence to convince believers in metastasectomy to reconsider their oncological practice? Eur J Cardiothorac Surg 2021; 59:517-521. [PMID: 33332567 DOI: 10.1093/ejcts/ezaa450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics and Physical Sciences, University College London, London, UK
| | - Eric Van Cutsem
- Department of Gastrointestinal and Liver Diseases, Digestive Oncology Unit, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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24
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Treasure T, Farewell V, Macbeth F, Batchelor T, Milošević M, King J, Zheng Y, Leonard P, Williams NR, Brew‐Graves C, Fallowfield L. The Pulmonary Metastasectomy in Colorectal Cancer cohort study: Analysis of case selection, risk factors and survival in a prospective observational study of 512 patients. Colorectal Dis 2021; 23:1793-1803. [PMID: 33783109 PMCID: PMC8496511 DOI: 10.1111/codi.15651] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/23/2021] [Indexed: 01/02/2023]
Abstract
AIM We wanted to examine survival in patients with resected colorectal cancer (CRC) whose lung metastases are or are not resected. METHODS Teams participating in the study of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) identified potential candidates for lung metastasectomy and invited their consent to join Stage 1. Baseline data related to CRC and fitness for surgery were collected. Eligible patients were invited to consent for randomization in the PulMiCC randomized controlled trial (Stage 2). Sites were provided with case report forms for non-randomized patients to record adverse events and death at any time. They were all reviewed at 1 year. Baseline and survival data were analysed for the full cohort. RESULTS Twenty-five clinical sites recruited 512 patients from October 2010 to January 2017. Data collection closed in October 2020. Before analysis, 28 patients with non-CRC lung lesions were excluded and three had withdrawn consent leaving 481. The date of death was known for 292 patients, 136 were alive in 2020 and 53 at earlier time points. Baseline factors and 5-year survival were analysed in three strata: 128 non-randomized patients did not have metastasectomy; 263 had elective metastasectomy; 90 were from the randomized trial. The proportions of solitary metastases for electively operated and non-operated patients were 69% and 35%. Their respective 5-year survivals were 47% and 22%. CONCLUSION Survival without metastasectomy was greater than widely presumed. Difference in survival appeared to be largely related to selection. No inference can be drawn about the effect of metastasectomy on survival in this observational study.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
| | | | | | - Tim Batchelor
- Bristol Royal InfirmaryUniversity HospitalsBristolUK
| | - Mišel Milošević
- Institute for Lung Diseases of VojvodinaThoracic Surgery ClinicSremska KamenicaSerbia
| | - Juliet King
- Thoracic SurgeryGuy's and St Thomas'HospitalLondonUK
| | - Yan Zheng
- Department of Thoracic SurgeryAffiliated Cancer Hospital of ZhengZhou University/Henan Cancer HospitalZheng ZhouChina
| | - Pauline Leonard
- Barking, Havering and Redbridge University HospitalsRomfordUK
| | - Norman R. Williams
- Surgical and Interventional Trials Unit (SITU)University College LondonLondonUK
| | - Chris Brew‐Graves
- National Cancer Imaging Accelerator (NCIA)Division of MedicineUniversity College LondonLondonUK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE‐C)University of SussexFalmerUK
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Macbeth F, Hughes-Davies L. Should We be Offering our Patients with Oligometastases Stereotactic Ablative Body Radiotherapy - No. Clin Oncol (R Coll Radiol) 2021; 33:749-750. [PMID: 34218999 DOI: 10.1016/j.clon.2021.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022]
Affiliation(s)
- F Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK.
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Treasure T, Macbeth F. The evidence for surgical interventions: Lung metastasectomy outcomes in the PulMiCC trial, an observational cohort study, and big data analysis. Colorectal Dis 2021; 23:1932-1933. [PMID: 33894024 DOI: 10.1111/codi.15686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Macbeth F, Williams NR, Treasure T. Pulmonary metastasectomy in colorectal cancer: a randomized controlled trial. ANZ J Surg 2021; 91:473. [PMID: 33740304 DOI: 10.1111/ans.16658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Abstract
Lung metastases are a common site of spread for many malignant tumours. Pulmonary metastasectomy has been practiced for many years for sarcomas and is now becoming increasingly frequently advocated for patients with many other tumours, especially colorectal cancer. In this article we argue that this procedure is one framed by therapeutic opportunity and not supported by strong evidence. It is potentially harmful and may not be effective. Our argument is based on several important issues: (I) the vagueness of the concept of “oligometastases” and its biological implausibility; (II) the flaws in the often-cited observational evidence, especially selection bias; (III) the lack of any reliable randomised trial evidence of improved survival but evidence of harm; (IV) the failure of strategies to detect metastases earlier to influence overall survival. The introduction of stereotactic radiotherapy and image-guided thermal ablation have made the urge to treat lung metastases stronger but without any good evidence to justify their use. We acknowledge the problems of carrying out randomised trials when there is a clear lack of equipoise in the clinical teams involved but believe that there is an ethical need to do so. Many patients are probably being given false hope of cure or prolonged survival but are at risk of harm from pulmonary metastasectomy or ablation. It is possible that a few patients may benefit but without better evidence we do not know which, if any, do.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK.
| | - Raymond Abratt
- Icon Oncology, Cape Town, South Africa; Division of Radiation Oncology, Department of Radiation Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Lyman GH, Carrier M, Ay C, Di Nisio M, Hicks LK, Khorana AA, Leavitt AD, Lee AYY, Macbeth F, Morgan RL, Noble S, Sexton EA, Stenehjem D, Wiercioch W, Kahale LA, Alonso-Coello P. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv 2021; 5:927-974. [PMID: 33570602 PMCID: PMC7903232 DOI: 10.1182/bloodadvances.2020003442] [Citation(s) in RCA: 363] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common complication among patients with cancer. Patients with cancer and VTE are at a markedly increased risk for morbidity and mortality. OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer. METHODS ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The guideline development process was supported by updated or new systematic evidence reviews. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess evidence and make recommendations. RESULTS Recommendations address mechanical and pharmacological prophylaxis in hospitalized medical patients with cancer, those undergoing a surgical procedure, and ambulatory patients receiving cancer chemotherapy. The recommendations also address the use of anticoagulation for the initial, short-term, and long-term treatment of VTE in patients with cancer. CONCLUSIONS Strong recommendations include not using thromboprophylaxis in ambulatory patients receiving cancer chemotherapy at low risk of VTE and to use low-molecular-weight heparin (LMWH) for initial treatment of VTE in patients with cancer. Conditional recommendations include using thromboprophylaxis in hospitalized medical patients with cancer, LMWH or fondaparinux for surgical patients with cancer, LMWH or direct oral anticoagulants (DOAC) in ambulatory patients with cancer receiving systemic therapy at high risk of VTE and LMWH or DOAC for initial treatment of VTE, DOAC for the short-term treatment of VTE, and LMWH or DOAC for the long-term treatment of VTE in patients with cancer.
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Affiliation(s)
- Gary H Lyman
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Marc Carrier
- Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottawa, ON, Canada
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Marcello Di Nisio
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti, Italy
| | - Lisa K Hicks
- Division of Hematology/Oncology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Alok A Khorana
- Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, OH
| | - Andrew D Leavitt
- Department of Laboratory Medicine and
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Agnes Y Y Lee
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Medical Oncology, BC Cancer, Vancouver site, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Simon Noble
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | | | - Wojtek Wiercioch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lara A Kahale
- American University of Beirut (AUB) Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Center, American University of Beirut, Beirut, Lebanon; and
| | - Pablo Alonso-Coello
- Cochrane Iberoamérica, Biomedical Research Institute Sant Pau-CIBERESP, Barcelona, Spain
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Batchelor T, Hasan J, Macbeth F, Shackcloth M, Treasure T. Randomised Controlled Trial Evidence Questions the Assumption that Pulmonary Metastasectomy Benefits Patients with Colorectal Cancer. Ann Surg Oncol 2021; 28:4066-4067. [PMID: 33590363 DOI: 10.1245/s10434-020-09521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
Pulmonary metastasectomy for sarcoma is surgery without proven benefit, and in the light of a randomized controlled trial examining pulmonary metastasectomy in colorectal cancer, it should be questioned.
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Affiliation(s)
| | | | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Tom Treasure
- Clinical Operational Research Unit, University College, London, UK.
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Treasure T, Macbeth F, Farewell V, Williams NR, Fallowfield L. The fallacy of large survival gains from lung metastasectomy in colorectal cancer. Lancet 2021; 397:97-98. [PMID: 33422259 DOI: 10.1016/s0140-6736(20)32760-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/27/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London WC1E 6BT, UK.
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London WC1E 6BT, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, University of Sussex, Falmer, UK
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Brew-Graves C, Farewell V, Monson K, Milošević M, Williams NR, Morris E, Macbeth F, Treasure T, Fallowfield L. Pulmonary metastasectomy in colorectal cancer: health utility scores by EQ-5D-3L in a randomized controlled trial show no benefit from lung metastasectomy. Colorectal Dis 2021; 23:200-205. [PMID: 33002305 PMCID: PMC7612179 DOI: 10.1111/codi.15386] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 02/08/2023]
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.
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Affiliation(s)
- Chris Brew-Graves
- National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, UK
| | - Vernon Farewell
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Kathryn Monson
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Mišel Milošević
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Norman R. Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, UK
| | - Eva Morris
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, UK
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34
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Williams NR, Macbeth F, Treasure T. Pulmonary metastasectomy in colorectal cancer: PulMiCC and future trials. Quant Imaging Med Surg 2020; 10:2215-2217. [PMID: 33140001 DOI: 10.21037/qims-20-774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Williams NR, Treasure T, Macbeth F. Pulmonary Metastasectomy for Colorectal Cancer: Randomized Controlled Trial. Radiology 2020; 298:E54-E55. [PMID: 33107803 DOI: 10.1148/radiol.2020202862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, Gower Street, London WC1E 6BT, England
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, Wales
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Milosevic M, Treasure T, Macbeth F. PulMiCC and data from other randomized controlled trials challenge the usefulness of metastasectomy. Eur J Cardiothorac Surg 2020; 59:ezaa291. [PMID: 33006614 DOI: 10.1093/ejcts/ezaa291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/13/2020] [Indexed: 11/08/2023] Open
Affiliation(s)
- Misel Milosevic
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics and Physical Sciences, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Treasure T, Leonard P, Milosevic M, Williams NR, Macbeth F, Farewell V. Pulmonary Metastasectomy in Colorectal Cancer: the PulMiCC randomised controlled trial. Br J Surg 2020; 107:e489-e490. [PMID: 32820820 DOI: 10.1002/bjs.11948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, Sremska Kamenica, Serbia
| | - Pauline Leonard
- Barking, Havering and Redbridge University Hospitals NHS Trust, Sremska Kamenica, Serbia
| | - Misel Milosevic
- Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
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Milosevic M, Edwards J, Tsang D, Dunning J, Shackcloth M, Batchelor T, Coonar A, Hasan J, Davidson B, Marchbank A, Grumett S, Williams N, Macbeth F, Farewell V, Treasure T. Pulmonary Metastasectomy in Colorectal Cancer: updated analysis of 93 randomized patients - control survival is much better than previously assumed. Colorectal Dis 2020; 22:1314-1324. [PMID: 32388895 PMCID: PMC7611567 DOI: 10.1111/codi.15113] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022]
Abstract
AIM Lung metastases from colorectal cancer are resected in selected patients in the belief that this confers a significant survival advantage. It is generally assumed that the 5-year survival of these patients would be near zero without metastasectomy. We tested the clinical effectiveness of this practice in Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), a randomized, controlled noninferiority trial. METHOD Multidisciplinary teams in 14 hospitals recruited patients with resectable lung metastases into a two-arm trial. Randomization was remote and stratified according to site, with minimization for age, sex, primary cancer stage, interval since primary resection, prior liver involvement, number of metastases and carcinoembryonic antigen level. The trial management group was blind to patient allocation until after intention-to-treat analysis. RESULTS From 2010 to 2016, 93 participants were randomized. These patients were 35-86 years of age and had between one and six lung metastases at a median of 2.7 years after colorectal cancer resection; 29% had prior liver metastasectomy. The patient groups were well matched and the characteristics of these groups were similar to those of observational studies. The median survival after metastasectomy was 3.5 (95% CI: 3.1-6.6) years compared with 3.8 (95% CI: 3.1-4.6) years for controls. The estimated unadjusted hazard ratio for death within 5 years, comparing the metastasectomy group with the control group, was 0.93 (95% CI: 0.56-1.56). Use of chemotherapy or local ablation was infrequent and similar in each group. CONCLUSION Patients in the control group (who did not undergo lung metastasectomy) have better survival than is assumed. Survival in the metastasectomy group is comparable with the many single-arm follow-up studies. The groups were well matched with features similar to those reported in case series.
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Affiliation(s)
- M. Milosevic
- Institute for Lung Diseases of VojvodinaThoracic Surgery ClinicSremska KamenicaSerbia
| | - J. Edwards
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - D. Tsang
- Basildon and Thurrock University Hospitals NHS Foundation TrustBasildonUK
| | - J. Dunning
- South Tees Hospitals NHS Foundation TrustThe James Cook University HospitalMiddlesbroughUK
| | - M. Shackcloth
- Liverpool Heart And Chest Hospital NHS Foundation TrustLiverpoolUK
| | - T. Batchelor
- Bristol Royal InfirmaryUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - A. Coonar
- Royal Papworth Hospital NHS Foundation TrustCambridgeUK
| | - J. Hasan
- The Christie NHS Foundation TrustManchesterUK
| | - B. Davidson
- Division of SurgeryRoyal Free London NHS Foundation TrustUCLLondonUK
| | - A. Marchbank
- Derriford HospitalUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | - S. Grumett
- The Royal Wolverhampton NHS TrustNew Cross HospitalWolverhamptonUK
| | - N.R. Williams
- Surgical & Interventional Trials Unit (SITU)University College LondonLondonUK
| | - F. Macbeth
- Centre for Trials ResearchCardiff UniversityCardiffUK
| | | | - T. Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
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Schünemann HJ, Ventresca M, Crowther M, Briel M, Zhou Q, Noble S, Macbeth F, Griffiths G, Garcia D, Lyman GH, Di Nisio M, Iorio A, Mbuagbaw L, Neumann I, van Es N, Brouwers M, Guyatt G, Streiff MB, Marcucci M, Baldeh T, Florez ID, Alma OG, Solh Z, Bossuyt PM, Kahale LA, Ageno W, Bozas G, Büller HR, Lebeau B, Lecumberri R, Loprinzi C, McBane R, Sideras K, Maraveyas A, Pelzer U, Perry J, Klerk C, Agnelli G, Akl EA. Evaluating prophylactic heparin in ambulatory patients with solid tumours: a systematic review and individual participant data meta-analysis. Lancet Haematol 2020; 7:e746-e755. [PMID: 32976752 DOI: 10.1016/s2352-3026(20)30293-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Study-level meta-analyses provide high-certainty evidence that heparin reduces the risk of symptomatic venous thromboembolism for patients with cancer; however, whether the benefits and harms associated with heparin differ by cancer type is unclear. This individual participant data meta-analysis of randomised controlled trials examines the effect of heparin on survival, venous thromboembolism, and bleeding in patients with cancer in general and by type. METHODS In this systematic review and meta-analysis we searched MEDLINE, Embase, and The Cochrane Library for randomised controlled trials comparing parenteral anticoagulants with placebo or standard care in ambulatory patients with solid tumours and no indication for anticoagulation published from the inception of each database to January 14, 2017, and updated it on May 14, 2020, without language restrictions. We calculated the effect of parenteral anticoagulant administration on all-cause mortality, venous thromboembolism occurrence, and bleeding related outcomes through multivariable hierarchical models with patient-level variables as fixed effects and a categorical trial variable as a random effect, adjusting for age, cancer type, and metastatic status. Interaction terms were tested to investigate effects in predefined subgroups. This study is registered with PROSPERO, CRD42013003526. FINDINGS We obtained individual participant data from 14 of 20 eligible randomised controlled trials (8278 [79%] of 10 431 participants; 4139 included in the low-molecular-weight heparin group and 4139 in the control group). Meta-analysis showed an adjusted relative risk (RR) of mortality at 1 year of 0·99 (95% CI 0·93-1·06) and a hazard ratio of 1·01 (95% CI 0·96-1·07). The number of patients with venous thromboembolic events was 158 (4·0%) of 3958 with available data in the low-molecular-weight heparin group compared with 279 (7·1%) of 3957 in the control group. Major bleeding events occurred in 71 (1·7%) of 4139 patients in the control population and 88 (2·1%) in the low-molecular-weight heparin group, and minor bleeding events in 478 (12·1%) of 3945 patients with available data in the control group and 652 (16·6%) of 3937 patients in the low-molecular-weight heparin group. The adjusted RR was 0·58 (95% CI 0·47-0·71) for venous thromboembolism, 1·27 (0·92-1·74) for major bleeding, and 1·34 (1·19-1·51) for minor bleeding. Prespecified subgroup analysis of venous thromboembolism occurrence by cancer type identified the most certain benefit from heparin treatment in patients with lung cancer (RR 0·59 [95% CI 0·42-0·81]), which dominated the overall reduction in venous thromboembolism. Certainty of the evidence for the outcomes ranged from moderate to high. INTERPRETATION Low-molecular-weight heparin reduces risk of venous thromboembolism without increasing risk of major bleeding compared with placebo or standard care in patients with solid tumours, but it does not improve survival. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Holger J Schünemann
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Matthew Ventresca
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthias Briel
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Qi Zhou
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, Wales, UK
| | - Fergus Macbeth
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK
| | - Gareth Griffiths
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, Wales, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - David Garcia
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Gary H Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington School of Medicine, Seattle, WA, USA
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G D'Annunzio, Chieti-Pescara, Italy; Department of Vascular Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Alfonso Iorio
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Division of Haematology, Department of Medicine, McMaster University, Hamilton, ON, Canada; Division of Haematology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Ignacio Neumann
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nick van Es
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Vascular Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Melissa Brouwers
- Faculty of Medicine, School of Epidemiology and Public Heath, University of Ottawa, Ottawa, ON, Canada
| | - Gordon Guyatt
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michael B Streiff
- Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maura Marcucci
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Tejan Baldeh
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ivan D Florez
- Michael G DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Paediatrics, Universidad de Antioquia, Medellin, Colombia
| | | | - Ziad Solh
- Transfusion Medicine Section, Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Lara A Kahale
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - George Bozas
- Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Harry R Büller
- Department of Vascular Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Bernard Lebeau
- Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Ramon Lecumberri
- Haematology Service, University Clinic of Navarra, Pamplona, Spain
| | - Charles Loprinzi
- Divisions of Cardiology and Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Robert McBane
- Divisions of Vascular Medicine and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Kostandinos Sideras
- Divisions of Medical Oncology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Anthony Maraveyas
- Division of Cancer, Hull York Medical School, University of Hull, Hull, UK
| | - Uwe Pelzer
- Division of Haematology, Oncology and Tumour Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität - Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - James Perry
- Ontario Clinical Oncology Group and Department of Oncology, McMaster University, Hamilton, ON, Canada; Division of Neurology, Sunnybrook Health Science Centre, Toronto, ON, Canada
| | - Clara Klerk
- Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, Netherlands
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Macbeth F, Webster A. Understanding bias in the medical literature: With reflections on metastasectomy. South African Journal of Oncology 2020. [DOI: 10.4102/sajo.v4i0.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Macbeth F, Fallowfield DL. Reply to 'Comment on "The myth of pulmonary metastasectomy'". Br J Cancer 2020; 123:1835-1836. [PMID: 32958822 PMCID: PMC7722899 DOI: 10.1038/s41416-020-01062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Fergus Macbeth
- Centre for Trial Research, Cardiff University, Cardiff, UK.
| | - Dame Lesley Fallowfield
- Sussex Health Outcomes Research & Education (SHORE-C), Brighton & Sussex Medical School, University of Sussex, Falmer, BN1 9RR, UK
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Abstract
Pulmonary metastasectomy is widely and increasingly practiced in the belief that this intervention can cure patients with colorectal cancer, and that without it few survive 5 years. No good evidence exists supporting such convictions, indeed recent trial results challenge them. What evidence underpins this acceptance of illusory truths or misconceptions?
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Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK.
| | - Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Sussex, UK
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van Es N, Ventresca M, Di Nisio M, Zhou Q, Noble S, Crowther M, Briel M, Garcia D, Lyman GH, Macbeth F, Griffiths G, Iorio A, Mbuagbaw L, Neumann I, Brozek J, Guyatt G, Streiff MB, Baldeh T, Florez ID, Gurunlu Alma O, Agnelli G, Ageno W, Marcucci M, Bozas G, Zulian G, Maraveyas A, Lebeau B, Lecumberri R, Sideras K, Loprinzi C, McBane R, Pelzer U, Riess H, Solh Z, Perry J, Kahale LA, Bossuyt PM, Klerk C, Büller HR, Akl EA, Schünemann HJ. The Khorana score for prediction of venous thromboembolism in cancer patients: An individual patient data meta-analysis. J Thromb Haemost 2020; 18:1940-1951. [PMID: 32336010 DOI: 10.1111/jth.14824] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/21/2020] [Accepted: 03/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Oncology guidelines suggest using the Khorana score to select ambulatory cancer patients receiving chemotherapy for primary venous thromboembolism (VTE) prevention, but its performance in different cancers remains uncertain. OBJECTIVE To examine the performance of the Khorana score in assessing 6-month VTE risk, and the efficacy and safety of low-molecular-weight heparin (LMWH) among high-risk Khorana score patients. METHODS This individual patient data meta-analysis evaluated (ultra)-LMWH in patients with solid cancer using data from seven randomized controlled trials. RESULTS A total of 3293 patients from the control groups with an available Khorana score had lung (n = 1913; 58%), colorectal (n = 452; 14%), pancreatic (n = 264; 8%), gastric (n = 201; 6%), ovarian (n = 184; 56%), breast (n = 164; 5%), brain (n = 84; 3%), or bladder cancer (n = 31; 1%). The 6-month VTE incidence was 9.8% among high-risk Khorana score patients and 6.4% among low-to-intermediate-risk patients (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2). The dichotomous Khorana score performed differently in lung cancer patients (OR 1.1; 95% CI, 0.72-1.7) than in the group with other cancer types (OR 3.2; 95% CI, 1.8-5.6; Pinteraction = .002). Among high-risk patients, LMWH decreased the risk of VTE by 64% compared with controls (OR 0.36; 95% CI, 0.22-0.58), without increasing the risk of major bleeding (OR 1.1; 95% CI, 0.59-2.1). CONCLUSION The Khorana score was unable to stratify patients with lung cancer based on their VTE risk. Among those with other cancer types, a high-risk score was associated with a three-fold increased risk of VTE compared with a low-to-intermediate risk score. Thromboprophylaxis was effective and safe in patients with a high-risk Khorana score.
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Affiliation(s)
- Nick van Es
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Matthew Ventresca
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy
| | - Qi Zhou
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Wales, UK
| | - Mark Crowther
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Matthias Briel
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
| | - David Garcia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Gary H Lyman
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Fergus Macbeth
- Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK
| | - Gareth Griffiths
- Centre for Trials Research, School of Medicine, Cardiff University, Wales, UK
- Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Alfonso Iorio
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Division of Hematology, Department of Medicine, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Ignacio Neumann
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jan Brozek
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Gordon Guyatt
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Michael B Streiff
- Division of Hematology, Department of Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tejan Baldeh
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Ivan D Florez
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Paediatrics, Universidad de Antioquia, Medellin, Colombia
| | | | - Giancarlo Agnelli
- Internal Vascular and Emergency Medicine-Stroke Unit, Università di Perugia, Perugia, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Maura Marcucci
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - George Bozas
- Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Gilbert Zulian
- Department of Readaptation and Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Anthony Maraveyas
- Division of Cancer-Hull York Medical School, University of Hull, Hull, UK
| | - Bernard Lebeau
- Service de Pneumologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Ramon Lecumberri
- Hematology Service, University Clinic of Navarra, Pamplona, Spain
| | - Kostandinos Sideras
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Charles Loprinzi
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Robert McBane
- Divisions of Medical Oncology, Cardiology and Hematology, Mayo Clinic, Rochester, MN, USA
| | - Uwe Pelzer
- Division of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Berlin Institute of Health, Freie Universität Berlin, Humboldt Universität-Universität zu Berlin, Berlin, Germany
| | - Hanno Riess
- Department of Hematology, Oncology, and Tumor Immunology, Charité, University Hospital, Berlin, Germany
| | - Ziad Solh
- Transfusion Medicine Section, Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - James Perry
- Division of Neurology, Sunnybrook Health Science Centre, Toronto, ON, Canada
- Ontario Clinical Oncology Group and Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Lara A Kahale
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam, The Netherlands
| | - Clara Klerk
- Department of Internal Medicine, Dijklanderziekenhuis, Hoorn, The Netherlands
| | - Harry R Büller
- Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Elie A Akl
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Holger J Schünemann
- Michael G. DeGroote Cochrane Canada and McGRADE Centres, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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Baum M, Fallowfield L, Farewell V, Macbeth F, Treasure T. NICE Guidelines: management of colorectal cancer metastases. Br J Surg 2020; 107:e357. [PMID: 32652538 DOI: 10.1002/bjs.11789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 01/16/2023]
Affiliation(s)
- M Baum
- University College, Sussex, UK
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Sussex, UK
| | | | - F Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Ventresca M, Schünemann HJ, Macbeth F, Clarke M, Thabane L, Griffiths G, Noble S, Garcia D, Marcucci M, Iorio A, Zhou Q, Crowther M, Akl EA, Lyman GH, Gloy V, DiNisio M, Briel M. Obtaining and managing data sets for individual participant data meta-analysis: scoping review and practical guide. BMC Med Res Methodol 2020; 20:113. [PMID: 32398016 PMCID: PMC7218569 DOI: 10.1186/s12874-020-00964-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Shifts in data sharing policy have increased researchers' access to individual participant data (IPD) from clinical studies. Simultaneously the number of IPD meta-analyses (IPDMAs) is increasing. However, rates of data retrieval have not improved. Our goal was to describe the challenges of retrieving IPD for an IPDMA and provide practical guidance on obtaining and managing datasets based on a review of the literature and practical examples and observations. METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library, until January 2019, to identify publications focused on strategies to obtain IPD. In addition, we searched pharmaceutical websites and contacted industry organizations for supplemental information pertaining to recent advances in industry policy and practice. Finally, we documented setbacks and solutions encountered while completing a comprehensive IPDMA and drew on previous experiences related to seeking and using IPD. RESULTS Our scoping review identified 16 articles directly relevant for the conduct of IPDMAs. We present short descriptions of these articles alongside overviews of IPD sharing policies and procedures of pharmaceutical companies which display certification of Principles for Responsible Clinical Trial Data Sharing via Pharmaceutical Research and Manufacturers of America or European Federation of Pharmaceutical Industries and Associations websites. Advances in data sharing policy and practice affected the way in which data is requested, obtained, stored and analyzed. For our IPDMA it took 6.5 years to collect and analyze relevant IPD and navigate additional administrative barriers. Delays in obtaining data were largely due to challenges in communication with study sponsors, frequent changes in data sharing policies of study sponsors, and the requirement for a diverse skillset related to research, administrative, statistical and legal issues. CONCLUSIONS Knowledge of current data sharing practices and platforms as well as anticipation of necessary tasks and potential obstacles may reduce time and resources required for obtaining and managing data for an IPDMA. Sufficient project funding and timeline flexibility are pre-requisites for successful collection and analysis of IPD. IPDMA researchers must acknowledge the additional and unexpected responsibility they are placing on corresponding study authors or data sharing administrators and should offer assistance in readying data for sharing.
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Affiliation(s)
- Matthew Ventresca
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Fergus Macbeth
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Mike Clarke
- Northern Ireland Hub for Trials Methodology Research and Cochrane Individual Participant Data Meta-analysis Methods Group, Queen’s University Belfast, Belfast, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Gareth Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Wales, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, Wales, UK
| | - David Garcia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gary H. Lyman
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington USA
| | - Viktoria Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marcello DiNisio
- Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
| | - Matthias Briel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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Macbeth F, Treasure T. Local treatment of 'Oligometastases': Wishful thinking is not supported by available evidence. Clin Oncol (R Coll Radiol) 2020; 32:409. [PMID: 32173145 DOI: 10.1016/j.clon.2020.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/25/2020] [Indexed: 02/02/2023]
Affiliation(s)
- F Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Affiliation(s)
- Fergus Macbeth
- Clinical Operational Research Unit, University College London, London WC1H 0BT, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London WC1H 0BT, UK.
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Treasure T, Farewell V, Macbeth F, Monson K, Williams NR, Brew-Graves C, Lees B, Grigg O, Fallowfield L. Pulmonary Metastasectomy versus Continued Active Monitoring in Colorectal Cancer (PulMiCC): a multicentre randomised clinical trial. Trials 2019; 20:718. [PMID: 31831062 PMCID: PMC6909580 DOI: 10.1186/s13063-019-3837-y] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 10/23/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lung metastasectomy in the treatment of advanced colorectal cancer has been widely adopted without good evidence of survival or palliative benefit. We aimed to test its effectiveness in a randomised controlled trial (RCT). METHODS Multidisciplinary teams in 13 hospitals recruited participants with potentially resectable lung metastases to a multicentre, two-arm RCT comparing active monitoring with or without metastasectomy. Other local or systemic treatments were decided by the local team. Randomisation was remote and stratified by site with minimisation for age, sex, primary cancer stage, interval since primary resection, prior liver involvement, the number of metastases, and carcinoembryonic antigen level. The central Trial Management Group were blind to patient allocation until completion of the analysis. Analysis was on intention to treat with a margin for non-inferiority of 10%. RESULTS Between December 2010 and December 2016, 65 participants were randomised. Characteristics were well-matched in the two arms and similar to those in reported studies: age 35 to 86 years (interquartile range (IQR) 60 to 74); primary resection IQR 16 to 35 months previously; stage at resection T1, 2 or 3 in 3, 8 and 46; N1 or N2 in 31 and 26; unknown in 8. Lung metastases 1 to 5 (median 2); 16/65 had previous liver metastases; carcinoembryonic antigen normal in 55/65. There were no other interventions in the first 6 months, no crossovers from control to treatment, and no treatment-related deaths or major adverse events. The Hazard ratio for death within 5 years, comparing metastasectomy with control, was 0.82 (95%CI 0.43, 1.56). CONCLUSIONS Because of poor and worsening recruitment, the study was stopped. The small number of participants in the trial (N = 65) precludes a conclusive answer to the research question given the large overlap in the confidence intervals in the proportions still alive at all time points. A widely held belief is that the 5-year absolute survival benefit with metastasectomy is about 35%: 40% after metastasectomy compared to < 5% in controls. The estimated survival in this study was 38% (23-62%) for metastasectomy patients and 29% (16-52%) in the well-matched controls. That is the new and important finding of this RCT. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT01106261. Registered on 19 April 2010.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, WC1H 0BT, UK.
| | | | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4Y, UK
| | - Kathryn Monson
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Falmer, BN1 9RX, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, W1W 7JN, UK
| | - Chris Brew-Graves
- Surgical and Interventional Trials Unit (SITU), University College London, London, W1W 7JN, UK
| | - Belinda Lees
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, UK
| | | | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Falmer, BN1 9RX, UK
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Carter P, Fou L, Whiter F, Delgado Nunes V, Hasler E, Austin C, Macbeth F, Ward K, Kearney R. Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review. BJOG 2019; 127:28-35. [DOI: 10.1111/1471-0528.15958] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
- P Carter
- Research Department of Clinical Educational & Health Psychology University College London London UK
| | - L Fou
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - F Whiter
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - V Delgado Nunes
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - E Hasler
- National Guideline Alliance Royal College of Obstetricians and Gynaecologists London UK
| | - C Austin
- National Institute for Health and Care Excellence Manchester UK
| | - F Macbeth
- Centre for Trials Research Cardiff University Cardiff UK
| | - K Ward
- The Warrell Unit St Mary's Hospital Manchester UK
- Manchester Academic Health Science Centre University Hospitals NHS Foundation Trust Manchester UK
| | - R Kearney
- The Warrell Unit St Mary's Hospital Manchester UK
- Manchester Academic Health Science Centre University Hospitals NHS Foundation Trust Manchester UK
- Faculty of Medical Human Sciences University Institute of Human Development University of Manchester Manchester UK
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Treasure T, Macbeth F, Baum M, Shackcloth M, Edwards J, Batchelor T. P2.16-02 Randomising Patients into Trials of Thoracic Cancer Surgery: An Analysis of Patient and Cancer Team Behaviour in Practice. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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