Adjuvant therapy in patients with resected pancreatic adenocarcinoma: Analysis of treatment patterns in a Canadian provincial institution.
Notice bibliographique
Résumé
e16236 Background: In recent years adjuvant therapy (AT) options for pancreatic cancer have evolved. Compared to gemcitabine (Gem) alone, improved overall survival (OS) was demonstrated first in 2017 with gemcitabine and capecitabine (GemCap), and then further improved in 2018 with FOLFIRINOX. Given these options, we retrospectively reviewed the patterns of AT use in British Columbia (BC), Canada during these periods of availability of newer AT regimens. Methods: Patients (pts) treated at BC cancer centers between January 2017 to June 2018 (“GemCap era”), and July 2018 to December 2019 (“FOLFIRINOX era”), who had undergone curative intent resection and received at least one cycle of AT were included for chart review. Patient and disease characteristics, treatment details, and stated rationale for choice of AT regimen were collected. Analyses were performed with one-way ANOVA for comparison of means between regimens, and Chi-squared or Fisher Exact tests to determine correlation between clinicopathologic factors and likelihood of undergoing a given AT regimen. Results: 148 pts were identified: 67 treated in the GemCap era (Gem: 25, 37%, and GemCap: 42, 63%) and 81 treated in the FOLFIRINOX era (Gem: 26, 32%, GemCap: 20, 25%, FOLFIRINOX: 35, 43%). Examined variables included age, gender, ECOG, T and N stage, margins, lymphovascular invasion and post-operative CA19-9. In the GemCap era, use of GemCap vs. Gem was associated with younger average age (p = 0.001) and positive lymph node status (91% vs. 60%, p = 0.003). In the FOLFIRINOX era, use of Gem AT was associated with a delayed time from surgery to treatment (p = 0.045). AT assignment was not influenced by high volume vs low volume centre in the GemCap era. However, when not assigned treatment with FOLFIRINOX in the FOLFIRINOX era, pts were more likely to receive GemCap in low-volume centers, and more likely to recieve Gem in high-volume centers (p = 0.026). The most common stated reasons for choice of an inferior AT regimen were pt comorbidities or functional status (GemCap era: 24% and FOLFIRINOX era: 35%). In total, 40% of patients treated with GemCap and 49% of patients treated with FOLFIRINOX did not complete the intended treatment, with regimen-specific toxicity accounting for 32% (GemCap) and 29% (FOLFIRINOX) of incomplete treatment. Conclusions: With improvements in survival with newer AT regimens, the majority of pts in our real-world setting were assigned the more efficacious AT regimen. Within the limits of a small sample size, significant pt or disease factors predictive of AT assignment were not identified aside from age and lymph node positivity in the GemCap era, and time from surgery to treatment in the FOLFIRINOX era. However, many pts were not able to complete planned AT due to toxicity. Efforts to optimize pt eligibility to improve FOLFIRINOX tolerability are warranted.
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 | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,005 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».