Do all patients with primary retroperitoneal sarcoma benefit from resection?
Notice bibliographique
Résumé
e23549 Background: We aimed to determine the impact of early recurrence on the prognosis of patients who have undergone resection of primary retroperitoneal sarcoma (RPS) and to discover which preoperative patient/tumor features predict early recurrence. Methods: Consecutive patients with primary non-metastatic RPS who were managed at two high volume RPS referral centers between 03/2012 and 10/2019 were identified from prospectively maintained institutional databases. The primary study endpoint was Overall Survival (OS), defined as the time from diagnosis to death from any cause, estimated by the KM method. Patients were grouped by Disease-Free Interval following resection (DFI = 0-6, 7-12, 13-18, 19-24, > 24 mos). Univariate and multivariable analyses (UVA, MVA) were performed. The Sarculator risk calculator and the Inflammatory Biomarkers Prognostic Index (IBPI) were assessed as potential predictors of early recurrence, defined as DFI 0-6 mos. Results: 651 patients (median age = 62.7yrs, IQR = 51.9-71.3; F:M = 301:350) met inclusion criteria and form the study cohort. Median follow-up time was 75.9 mos (IQR 58.6-99.5). 566 of the 651 (87%) patients underwent resection of their primary RPS, while 85 (13%) did not, most commonly due to suboptimal PS. Of the 566 patients who underwent resection, 259 (46%) had developed a recurrence by the time of last follow-up, while 307 patients (54%) had not recurred. In the 259 patients whose tumor recurred, 49 (19%) recurred within 6 mos of primary RPS resection, 42 (16%) between 7 and 12 mos, 35 (14%) between 13 and 18 mos, 31 (12%) between 19 and 24 mos, and 102 (39%) after 24 mos. Patients who developed recurrence within 6 mos of resection had similar OS from the time of diagnosis to the 85 patients who did not have a resection (1-year estimates: 77.3% [95% CI: 66.4-90.1] vs 65.7% [56.1-76.8], respectively; 2-year estimates: 51.6% [39.1-68.0] vs 42.7% [33.1-55.1], p = 0.32), while patients who relapsed more than 6 mos after resection had longer OS than either of these groups (p < 0.001). Upon MVA, the HR for death in patients who recurred within 6 mos vs. that of patients who were not resected was 0.96 (95% CI: 0.60-1.53). No standard clinico-pathologic variable available preoperatively could be identified that predicted recurrence within 6 mos of primary resection. Neither composite score (Sarculator, IBPI) was able to reliably predict recurrence within 6 mos. Conclusions: DFI from primary RPS resection to first recurrence was less than 6 mos in ≈20% of patients. DFI directly correlated with OS from time of diagnosis. Patients who recurred within 6 mos of resection had an equivalent OS to patients who didn’t undergo resection, raising the question of whether resection was of any benefit. Current efforts focus on discovery of genomic characteristics that reflect adverse biology/host response and are discoverable preoperatively, in order to improve patient selection for surgery and for neoadjuvant therapy.
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 | 0,000 | 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) | 0,003 | 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 ».