Prognostic factors of gallbladder cancer (GBC) in patients diagnosed over a period of 20 years: A Canadian province experience.
Notice bibliographique
Résumé
437 Background: GBC is an uncommon but often fatal gastrointestinal cancer. The poor prognosis of GBC may in part be due to lack of effective screening tools and a delay in diagnosis that leads to presentation in the latter stages of the disease. The current study aims to determine outcomes of patients with GBC in relation to contextual, demographic and clinical factors in a Canadian province over a span of 20 years. Methods: In this population-based retrospective cohort study patients with GBC diagnosed in Saskatchewan, Canada from 2000-2019 were evaluated. Cox proportional multivariate regression analyses was performed to determine factor correlated with inferior outcomes. Results: 331 patients with median age of 74 yrs and M:F of 1:2 were identified. 92% had a pathological diagnosis of GBC & 80% had adenocarcinoma. 49% were diagnosed >year 2010. 217 (66%) of those diagnosed with GBC were rural residents. 149 (45%) patients were referred to a cancer center. In patients with documented stage, 64% had stage IV disease & >90% were symptomatic with a median time from the onset of symptoms to the diagnosis of 7 months. Rural residents have a significantly high rate of smoking history whereas urban residents have significantly high rates of pathological diagnosis, low serum albumin and elevated platelet count. Median overall survival (OS) of patients with stage I-III GBC was 20 months (95% CI:10.9-29.1) vs. 4.0 months (3.0-5.0) with stage IV GBC (<0.001). No significant differences were noted in OS in relation to residence and time-period of diagnosis. Patients who were not referred for a cancer center had a median OS of 3 months (1.98-4.0) vs. 13 months (9.9-16.1), p<0.001. Median disease-free survival (DFS) of patients with stage I-III GBC was 20 months (95%CI: 10-30.1) with 5-year DFS of 36%. Patients with stage I-III GBC who received adjuvant chemotherapy had 5-yr DFS of 43% vs. 33% without adjuvant chemotherapy (p=0.73). 5-year DFS of urban patients was 25% vs. 42% of rural patients (p=0.016). On multivariate analysis for patients with Stage I-III GBC, stage III disease, HR (hazard ratio), 2.63 (1.09-6.34) and urban residence, HR, 2.20 (1.1-4.39) were correlated with inferior DFS whereas for all patients, stage IV disease, HR, 3.02 (1.85-4.94); no referral to cancer center, HR, 2.64 (1.51-4.62); lack of surgery, HR, 1.63 (1.03-2.57); neutrophil:lymphocyte of >3.2, HR, 1.57 (1.05-2.36); and age ≥70, HR, 1.51 (1.04-2.19) were correlated with inferior OS. Conclusions: In a real-world setting, most patients with GBC are diagnosed with late-stage disease and were not referred to cancer center. For early-stage GBC, urban residence and stage III disease were correlated with inferior outcome, whereas for all stage GBC, stage IV disease, old age, lack of surgery, lack of referral to cancer center, and high neutrophil to lymphocyte ratio were correlated with inferior survival.
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 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| 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 ».