Canadian Association of General Surgeons and American College of Surgeons Evidence-Based Reviews in Surgery. 25.: Perioperative chemotherapy and surgery versus surgery alone for resectable gastric cancer
Bibliographic record
Abstract
Question: Does perioperative adjuvant therapy improve the outcome of operable gastric cancer? Design: Multicentre randomized controlled trial. Setting: Forty-five centres in the United Kingdom as well as centres in the Netherlands, Germany, Brazil, Singapore and New Zealand. Patients: Five hundred and three patients with histologically proven adenocarcinoma of the stomach, esophogastric junction or lower esophagus were randomized to perioperative chemotherapy plus surgery (n = 250 patients) or surgery alone (n = 253 patients). Interventions: Patients who were assigned to the perioperative chemotherapy and surgery group received 3 doses of chemotherapy (epirubicin, cisplatin and fluorouracil) preoperatively, followed by surgery 3–6 weeks after the third dose, and then 3 doses of postoperative chemotherapy beginning 6–12 weeks after surgery. Patients assigned to surgery alone were scheduled to have surgery within 6 weeks of randomization. The main outcome measure was overall survival. Secondary outcomes were progression-free survival, assessments of downstaging, the surgeon's assessment of whether the surgery was curative and quality of life. Results: Rates of postoperative complications were similar in both groups (46% v. 45%, respectively), as were the numbers of deaths within 30 days of surgery. The resected tumours were significantly smaller and less advanced in the group that received perioperative chemotherapy. With a mean follow-up of 4 years, 144 (60%) of the patients in the perioperative chemotherapy group and 170 (67%) of the patients in the surgery group died. The likelihood of overall survival was higher in the perioperative chemotherapy group (hazard ratio [HR] for death 0.75, 95% confidence interval [CI] 0.60–0.93; p = 0.009; 5-year survival rate 36% v. 23%), as was the likelihood of progression-free survival (HR for progression 0.66; 95% CI 0.53–0.81; p < 0.001). Conclusion: Compared with the group receiving surgery alone, overall survival improved in the group receiving perioperative chemotherapy, as did progression-free survival among patients with resectable adenocarcinoma of the stomach, esophogastric junction or lower esophagus.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.057 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.004 |
| Bibliometrics | 0.010 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.013 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".