The prognostic value of degree of pre- and post-treatment anemia in patients with advanced gastroesophageal cancers.
Notice bibliographique
Résumé
e16012 Background: Anemia is common in cancer patients and cancer-related anemia has been associated with poorer clinical outcomes in various malignancies. The degree of anemia in patients receiving chemotherapy, as a prognostic factor in gastroesophageal cancers (GE), is not well understood. There have been studies looking at clinical prognostic scores and their efficacy of predicting outcomes, of which the Gustave Roussy Immune (GRIm-Score) has been seen to be most predictive of early death in GE cancers. This study aims to compare hemoglobin (g/L) values before treatment and at multiple longitudinal timepoints during treatment as a prognostic marker of overall survival (OS) and progression-free survival (PFS). It also aims to identify whether various laboratory measures in the GRIm-Score, which includes lactate dehydrogenase (LDH), neutrophil to lymphocyte ratio (NLR) and body mass index (BMI) may hold prognostic value. Methods: A retrospective analysis of 171 patients with advanced GE cancer receiving first-line palliative-intent systemic therapy at the Princess Margaret Cancer Centre in Toronto, Canada from 2011 to 2021 was performed. Laboratory data were longitudinally collected across four time points: pre-chemotherapy, at first restaging scan, at disease progression and at final blood draw at last known follow up. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to assess the association between change in hemoglobin from baseline, adjusted for LDH, NLR and BMI. Results: Mean hemoglobin value decreased with chemotherapy initiation at the first staging time point compared to pre-chemotherapy values by 10.82 g/L (-10.82, CI: -13.57, -8.07, p < 0.001). On univariate analysis, patients with a hemoglobin increase of 10 g/L at their final blood draw compared to pre-chemotherapy decreased their overall risk of death by 8.50% (HR 0.915, CI: 0.843-0.993, p = 0.033) as well as their PFS by 6.90% (HR 0.931, CI: 0.873-0.994, p = 0.031). On multivariable analysis, adjusting for relevant clinical factors including LDH, NLR and BMI, an increase in hemoglobin increase of 10 g/L from baseline to final was associated with better OS (HR 0.893, CI: 0.817-0.977, p = 0.01). On multivariate analysis, an increase in LDH at progression bloodwork compared to baseline levels was associated with poorer OS (HR 1.002, CI: 1.001-1.003, p = 0.026) and an increase in NLR at final blood draw compared to baseline was associated with poorer OS (HR 1.02, CI: 1.012-1.028, p < 0.001). Conclusions: Patients with metastatic GE cancers can develop treatment-associated anemia and this prognosticates a poorer overall survival. Prognostic models incorporating change in hemoglobin, LDH and NLR ratios should be considered in future clinical evaluation of metastatic GE cancers.
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 | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| 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 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 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 ».