Adjuvant chemotherapy outcomes among patients with stage II early-onset colon cancer in Alberta.
Notice bibliographique
Résumé
e15629 Background: Incidence rates of early-onset colorectal cancer (eoCRC) among adults under the age of 50 years are increasing in Canada and the United States. Despite increasing incidence, eoCRCs represent a minority of CRC diagnoses (~10%) and are underrepresented in randomized trials of novel chemotherapies and targeted agents. As such, robust evidence that can be used to inform the clinical management of eoCRC is lacking. In particular, the appropriateness of adjuvant chemotherapy for individuals with stage II colon cancer is controversial. Given this uncertainty, there is an urgent need for data to clarify whether these practices are helpful or harmful. Objective: This project leveraged existing real-world data to investigate treatment outcomes among eoCRC patients in Alberta and identify areas amenable to intervention. The specific aim was to assess the real-world effectiveness of initiating adjuvant chemotherapy vs. observation on survival in eoCRC. Methods: We conducted a population-based, retrospective cohort study including all patients aged 18to 49 years in Alberta diagnosed with invasive colon cancer from 2004 to 2020. Data from electronic medical records, administrative data claims, and vital statistics were linked. Observational data were used to emulate a target trial comparing the initiation of any adjuvant chemotherapy (fluorouracil/capecitabine-based regimens) vs. observation (no chemotherapy) within 12 weeks of diagnosis. The outcomes were recurrence-free and overall survival. Follow-up began at time of surgery and patients were followed until recurrence, death, last known date of contact with the healthcare system, or administrative end of follow-up (April 2022), whichever occurred first. To address time-varying selection bias, marginal Cox models with artificial cloning and inverse-probability censoring weights were employed to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). Results: A total of 230 patients were included, where 94 (41%) initiated chemotherapy and 136 (59%) did not. Patients initiating chemotherapy were more likely to have T4 tumours (42.6% vs. 8.1%), high grade tumours (20.3% vs. 11%) and fewer than 12 examined lymph nodes (8.5% vs. 2.9%). The median time-to-chemotherapy initiation since surgery was 55 days [IQR:38-72]. The risks of recurrence and death were 21% (HR:0.79; 95%CI:0.41-1.51) and 20% (HR:0.80; 95%CI:0.40-1.61) lower among those who initiated chemotherapy versus observation, respectively, but statistical significance was not achieved. Conclusions: Our study did not demonstrate significant survival benefits of initiating adjuvant chemotherapy in stage II early-onset colon cancer. However, we were limited in sample size, outcome events, and data on microsatellite instability. Future studies should explore prediction of high-risk status to identify patients more likely to benefit from adjuvant chemotherapy.
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 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| 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 ».