Patterns of care and treatment outcomes in older patients with biliary tract cancer
Bibliographic record
Abstract
// Anne Horgan 1, 2 , Jennifer Knox 1 , Priya Aneja 1 , Lisa Le 3 , Elizabeth McKeever 1 , Mairead McNamara 1, 4 1 Princess Margaret Cancer Centre, Department of Medical Oncology, Toronto, ON, Canada 2 Present address: University Hospital Waterford, Department of Medical Oncology, Ardkeen, Waterford, Ireland 3 Princess Margaret Cancer Centre, Department of Biostatistics, Toronto, ON, Canada 4 Present address: The Christie NHS Foundation Trust/University of Manchester, Institute of Cancer Sciences, Manchester, UK Correspondence to: Anne Horgan, e-mail: annem.horgan@hse.ie Keywords: biliary tract cancer, elderly, treatment Received: June 07, 2015 Accepted: October 27, 2015 Published: November 09, 2015 ABSTRACT Background: Although biliary tract cancers (BTC) are common in older age-groups, treatment approaches and outcomes are understudied in this population. Patients and Methods: Data from 913 patients diagnosed with BTC from January 1987 to July 2013 and treated at Princess Margaret Cancer Center, Toronto were analyzed. The differences in treatment patterns between older and younger patients were explored and the impact of age, patient and disease characteristics on survival outcomes was assessed. Results: Three hundred and twenty one patients ≥70 years were identified. Older patients were more likely to receive best supportive care, 40% ( n = 130), compared to younger patients 26% ( n = 154); p < 0.0001. On multivariable analysis, factors associated with receipt of surgery included stage I/II disease ( p < 0.0001) and ECOG PS < 2 ( p < 0.0001). Older age was not associated with lack of surgical intervention. In comparison, older age was associated with non-receipt of palliative chemotherapy ( p = 0.0007). Similar survival benefit from treatment was seen in older and younger patients. Of 626 patients that underwent either surgery or palliative chemotherapy ( n = 188), the median survival was 21.1 months (95% CI 19.0–27.9) in patients >70 years of age, and 21.1 months in younger patients ( n = 438) (95% CI 19.5–24.5). Conclusion: In this large retrospective analysis, older patients with BTC are less likely to undergo an intervention. However, active therapy when given is associated with similar survival benefits, irrespective of age.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".