P010: Inferior Outcomes for Young Adults Treated on Advanced Stage Clinical Trials: Report from the HoLISTIC Consortium
Notice bibliographique
Résumé
Figure 1: Relationship Between Age and Risk of Progression and Death (n=3893). Background: Inferior outcomes have been reported for adolescents and young adults (AYAs) across several cancer types, as compared to younger pediatric or older patients (pts). While lack of access to clinical trials has been implicated, we described inferior outcomes for AYAs treated on a large US Hodgkin Lymphoma (HL) adult study (Henderson, 2018). Earlier this year, in an analysis of three US phase 3 pediatric HL trials, worse outcomes were reported for pts >15 years (yrs) compared with younger pts (Kahn, 2022). Little is known about the impact of age on outcomes from recent adult clinical trials. Methods: Individual patient data from eight advanced stage clinical trials (ECOG2496, SWOG0816, HD2000, HD9601, HD0607, HD0801, UK Stanford V, and RATHL), conducted from 1996–2012, were harmonized as part of the HoLISTIC Consortium. Pts with classic HL, stage IIb, III or IV disease, ages 14–65 yrs, and treated at adult centers were included. Outcomes were 5-yr progression-free survival (PFS) and 5-yr overall survival (OS), which were estimated in univariable and multivariable models. Age at diagnosis and 10 other clinical factors, were examined with multivariable adjusted plots and piecewise linear splines to identify functional forms of the relationship with PFS or OS. Multiple imputation was used for missing data. Results: Data on 3893 HL patients were included. Across all studies, 5-year PFS was 76.5% (95% CI=75.1%, 77.9%); 5-year OS was 91.6% (95% CI=90.7%, 92.6%). Median age was 32 yrs and 41% of patients were <30 yrs at diagnosis. Associations between age (analyzed as a continuous variable) and PFS displayed a distinct piecewise linear relationship with an inflection point at age 30 (Figure A). In multivariable analyses, PFS improved from ages 14 to 30, and then declined after age 30 (Figure B). The association between age and OS was not significant <30 yrs, advancing age >30 yrs was associated with worse OS. These patterns were seen broadly across studies and not dominated by one trial. Conclusion: The association between age and HL survival in the modern era appears to be more nuanced than the dichotomous variable of age at 45 yrs, as used in previous models. While patients under 30 yrs have worse short-term disease outcomes than age 30 yrs, 5-yr OS results suggest that younger patients may be amenable to successful salvage. Further research is needed to understand these differences to optimize outcomes.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| 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 tête enseignante, 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 ».