RADIUM-223 TREATMENT IN PATIENTS WITH PROSTATE CANCER IN ONTARIO
Notice bibliographique
Résumé
Background: Radium-223 is an alpha-emitting radioactive calcium-mimetic nuclide preferentially distributed into high turnover bone affected by cancer cells after intravenous administration. It has been shown to reduce mortality in patients with boney metastases due to metastatic castration-resistant prostate cancer (mCRPC). However, which patients benefit most from radium-223 therapy remains an important unanswered question. Methods: Patients diagnosed with prostate adenocarcinoma and treated at least once with radium-223 in the province of Ontario between March 3, 2014 and March 31, 2023 were identified by the Institute for Clinical Evaluative Sciences (IC/ES) database. Physician billing codes were used to identify radium-223, chemotherapy, radiation therapy and surgical interventions. Drug identification numbers (DIN) were used to identify patients who had been exposed to androgen receptor axis-targeted agents (ARAT) and bone modifying agents (denosumab or zoledronate). Laboratory data was extracted from the Ontario Laboratories Information System (OLIS) and included blood prostate-specific antigen (PSA), albumin, alkaline phosphatase (ALP), hemoglobin levels; and blood leukocyte, lymphocyte and neutrophil counts. Results: A total of 1588 patients with prostate cancer received radium-223 treatment. Median age at treatment was 68 with approximately 20% (322) of patients diagnosed between 2002-2008, 50% (754) between 2009-2015 and 30% (512) between 2016-2022. Patients with metastatic disease at diagnosis comprised the majority of patients who received treatment (45.8% [728]), followed by 12.6% (200) with stage III and 23.8% (377) diagnosed at an early stage (I+II). Prior use of ARATs was seen in 27.6% (438) and 25.3% (401) of patients had prior use of a bone modifying agent. Median overall survival from diagnosis was 85.6 months while median overall survival from starting radium-223 was 12.3 months. In a multivariable model, higher pre-treatment hemoglobin (HR 0.82, 95% CI 0.78-0.85) and calcium (HR 0.21, 95% CI 0.14-0.32) levels were associated with longer survival and higher pre-treatment neutrophil count (HR 1.08, 95% CI 1.05-1.11), ALP (HR 1.08, 95% CI 1.06-1.11) and PSA levels (HR 1.02, 95% CI 1.01, 1.03) with shorter survival. Excluding laboratory values, older age (HR 1.02, 95% CI 1.02-1.03), prior use of ARATs (HR 1.24, 95% CI 1.06-1.45) and chemotherapy (HR 2.11, 95% CI 1.78, 2.51) were associated with worse survival while early stage at diagnosis (stage I [HR 0.41, 95% CI 0.23-0.74] and stage II [HR 0.73, 95%CI 0.61-0.88) were associated with longer survival. Analysis of demographic factors showed that rurality was associated with lower chance of receiving radium-223 but was not associated with worsening survival. Conclusion: Survival after radium-223 treatment in patients with mCRPC was influenced by disease biology, burden, and patient age. Patients residing in rural areas were less likely to receive radium-223 treatment suggesting barriers to access.
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 | 0,000 |
| 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) | 0,003 | 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 ».