Surgical management of the primary tumor in stage IV colorectal cancer: A validation study.
Bibliographic record
Abstract
675 Background: The observational studies have demonstrated superior survival of patients with stage IV CRC who undergo surgical resection of the primary tumor (SRPT). Yet the results are not confirmed in the setting of a randomized controlled trial. Lack of randomization and failure to control the prognostic variables that affect survival including performance status (PS) are the major critiques to the findings of observational studies. Our group has demonstrated that SRPT improves survival of stage IV CRC patients, who were diagnosed between 1992-2005, independent of age and PS (Cancer. 2014;120:683). The current study is undertaken to validate our findings in patients who are treated with modern chemotherapy. Methods: A cohort of 569 patients with stage IV CRC diagnosed between 2006-2010 in Saskatchewan was evaluated. Cox regression model was used to adjust survival for important prognostic variables. Results: Median age was 69 years (59-95) and M:F was 1.4:1. 35% had ECOG PS of >1. 313 (55%) patients underwent SRPT. Median followup time was 11 months (inter-quartile range 2-26). 57.3% received chemotherapy, 91.4% received FOLFIRI or FOLFOX and 67% received anti-EGFR inhibitors and or bevacizumab. Median overall survival (OS) of patients who had SPRT and received chemotherapy was 27 months compared with 14 months if they did not have surgery (p<0.0001). Median OS of patients who received all active agents and had SPRT was 39 months (95% CI: 25.1-52.9). On multivariate analysis SRPT, hazard ratio (HR) for mortality of 0.44 (95% CI: 0.35-0.56), use of chemotherapy, HR 0.33 (95% CI: 0.26-0.43), metastasectomy, HR 0.43 (95% CI: 0.31-0.58), second line therapy, HR 0.50 (95% CI: 0.35-0.70), and third line therapy, HR 0.58 (95% CI: 0.41-0.83) were independently correlated with superior survival. Elevated alkaline phosphatase, (HR 1.50 (95% CI: 1.20-1.78), grade 3 tumor, HR 1.33 (95% CI: 1.10-1.62), leukocytosis, HR 1.32 (95% CI: 1.05-1.66), stage IVb disease, HR 1.31 (95% CI: 1.10-1.56), and ECOG PS>1, HR 1.30 (95% CI: 1.04-1.57) were correlated with inferior survival. Conclusions: Our study supports SRPT in patients with stage IV CRC who are treated with modern combination of chemotherapy and biologics.
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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 | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".