De novo metastatic versus recurrent gastroesophageal cancer: A single-centre retrospective analysis.
Notice bibliographique
Résumé
282 Background: Outcomes remain poor for patients with metastatic gastric, gastroesophageal and esophageal adenocarcinoma (GEAC) with median survival of 14 months with combination chemotherapy and immunotherapy as per the Checkmate 649 trial. There is limited data to clarify if any differences exist between denovo metastatic and recurrent GEAC in terms of survival and response to systemic therapy. We compare the baseline characteristics and outcomes for patients with denovo metastatic and recurrent GEAC in our cohort. Methods: A retrospective observational analysis was conducted to include patients with metastatic GEAC reviewed at Princess Margaret Cancer Centre between 2007 and 2021. Baseline characteristics including age, sex, race, performance status and Charlson Comorbidity index (CCI) were reviewed. Outcomes of interest included overall survival (OS), progression free survival on first line (PFS1) and second line (PFS2) systemic therapy and disease-free interval (DFI) in the recurrent group (defined as time between initial diagnosis and development of recurrent disease). OS was calculated from diagnosis of stage IV disease. Cox proportional hazards and Kaplan Meier curves were used to compare OS, PFS1 and PFS2. Outcomes were adjusted for baseline characteristics. The effect of DFI on outcomes was evaluated in the recurrent group. Results: Our cohort consisted of 619 cases, of which 456 (73.6%) were denovo metastatic and 163(26.4%) were recurrent. The majority (71%) were male, non-Asian (85%) and median age for the cohort was 60 years. There were no significant differences in baseline characteristics and biomarker status (HER2, MSI) between denovo and recurrent groups. Number of metastatic sites was significantly higher in denovo group (Mean:2.3 vs 1.8, p<0.001). A significantly higher percentage of patients received immunotherapy in the first line setting in the recurrent group (8% vs 4%, p:0.04). Using multivariate cox regression and after adjusting for age, performance status and CCI, there was a significant difference in OS favoring recurrent group (aHR:0.70, 95% CI 0.57-0.86, p=<0.001). Using Kaplan Meier curves, median OS was 18.08 months in the recurrent group vs 14.62 months in the denovo metastatic group. There was a significant difference in PFS1 using a multivariate model in favor of the recurrent group (aHR 0.81,95% CI 0.67-0.99, p=0.04), as well as similar improvement in PFS2 for the recurrent group (aHR:0.69,95% CI 0.52-0.92, p=0.01). In the recurrent group, OS did not differ significantly between DFI <6 months, 6-12 months or >12 months. Conclusions: Our results show a significantly better OS, PFS1 and PFS 2 for recurrent as compared to denovo metastatic GEAC for patients treated in the 1st line metastatic setting in a large single-centre retrospective analysis. More in depth analysis of molecular differences in patient tumors is underway and may help to explain better outcomes.
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 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| 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 ».