How advanced lung cancer patients are really treated at the population level? The Ontario, Canada experience
Notice bibliographique
Résumé
Background: Clinical trials define treatment recommendations but patients in the real world may be unable or unwilling to undergo treatments with demonstrated efficacy in fit patients. The Canadian Partnership Against Cancer has developed a model of lung cancer (LC) management (OncoSim-lung) in 2008 based on clinical trials data and expert advice. To credibly project the future clinical and economic impacts of cancer control measures using OncoSim, the model has been refined using real-world data. Methods: Treatment data by histology and stage were extracted from the Ontario Cancer Registry for LC cohorts diagnosed in 2010 and 2013. All incident cases that satisfied the IARC rule of a new primary were included. Missing or unknown stage cases were excluded. Clinical pathways were validated by oncologists from different disciplines across Canada. Results: The 2013 cohort included 8,086 staged LC: NSCLC (n = 7,143) Stage I 18.7%, II 8%, III/IIIa 11.4%, IIIb 4.9% IV 56.8%; SCLC (n = 943) limited 67.7%, extensive 32.3%. Of 813 stage III/IIIa patients, only 26% underwent surgery, 41% of whom received adjuvant chemotherapy or postoperative radical radiotherapy (16%); 13% received trimodality treatment. Of the 75% of Stage III not receiving surgery, 26% had NAT and 21% had palliative radiotherapy alone. Of those receiving active treatment, 20% received combined chemo +radiotherapy and 13% each had chemotherapy alone or radical radiotherapy alone. Of 356 stage IIIb patients, 17% had NAT, 28% received palliative radiotherapy and only 30% had chemo + radical radiotherapy. 18% had chemo alone. Of 4055 stage IV NSCLC, 47% had NAT, 24% received chemotherapy alone and 23% had palliative radiotherapy only. Of those who received first-line chemotherapy (n = 1059), 47% received second line chemotherapy and of those, 37% received third line therapy. Conclusions: Compared to prior expert opinion, there was a much lower frequency of chemo-radiotherapy in Stage III disease and a higher frequency of NAT across all stages of disease. The updated OncoSim model will now have a credible real-world base from which the impacts of new treatment interventions on survival and budget impact can be better estimated. Legal entity responsible for the study: Canadian Partnership Against Cancer. Funding: Canadian Partnership Against Cancer. Disclosure: All authors have declared no conflicts of interest.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,004 |
| Études des sciences et des technologies | 0,005 | 0,002 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».