Morris Eva, Treasure Tom
Section of Epidemiology & Biostatistics (Institute of Cancer & Pathology (LICAP) and Institute of Data Analytics (LIDA)), Leeds, UK.
Clinical Operational Research Unit, University College London, London, UK.
Cancer Epidemiol. 2017 Aug;49:152-155. doi: 10.1016/j.canep.2017.06.009. Epub 2017 Jul 7.
An analysis of NHS data published in by Morris et al. in 2010 is widely used as evidence in support of liver metastasectomy for colorectal cancer and its wider application. Recent evidence concerning better overall survival for patients with metastatic colorectal cancer challenges the notional assumptions about what survival would be without metastasectomy. Earlier detection of metastases for local treatments has not resulted in a survival benefit.
The interpretation of its central graphical display is critically reviewed and the common the limitations of the analysis of registry data and resulting immortal time bias are explored.
Recent evidence, including the 2017 CLOCC trial report make the original interpretation of the analysis suspect. Randomised trials are essential to detect a treatment effect of specific interventions among variable disease progression, selection bias, and multiple and repeated treatments that are inherent in the management of advanced cancer.
莫里斯等人于2010年发表的对英国国家医疗服务体系（NHS）数据的分析被广泛用作支持结直肠癌肝转移切除术及其更广泛应用的证据。近期有关转移性结直肠癌患者总体生存率提高的证据对未进行转移切除术时生存率的概念性假设提出了挑战。早期检测转移灶以便进行局部治疗并未带来生存获益。
对其核心图形展示的解读进行了批判性审视，并探讨了登记数据分析的常见局限性以及由此产生的不朽时间偏倚。
包括2017年CLOCC试验报告在内的近期证据使该分析的原始解读受到质疑。在晚期癌症管理中固有的可变疾病进展、选择偏倚以及多种和重复治疗的情况下，随机试验对于检测特定干预措施的治疗效果至关重要。
