Patterns of care and outcomes of locally advanced breast cancer at the Cancer Centre of Southeastern Ontario
Bibliographic record
Abstract
e11614 Background: Preoperative chemotherapy (PCT) is the standard of care for locally advanced breast cancer (LABC). As part of a multicentre provincial initiative we undertook a review of practice patterns and outcomes for women with LABC at our institution. Methods: We reviewed electronic and paper records for M0 pts receiving PCT for LABC between 1995–2007 at our institution, collecting demographic, disease and treatment-related, and outcome variables. Results: Sixty pts with LABC who received PCT were included in this review. Median age was 54y (31–80), 38% premenopausal. Median BMI was 28kg/m2, 78% were overweight or obese. Stage distribution: 10% IIB, 11% IIIA, 77% IIIB and 2% IIIC, of which 45% had inflammatory breast cancer (IBC). At biopsy 90% were invasive ductal carcinoma, 36% were ER and PR(-) and 25% were her2(+). Median time from surgical consultation to PCT was 22d (6–126). PCT was anthracycline-based alone in 85% of pts, 8% received a taxane, 3% also received preop endocrine therapy (ET), no pts received trastuzumab (T) preop. Pts received a median of 6 (3–8) cycles of PCT. Local therapy: mastectomy (M) in 82% of pts and partial M in 11%. Axillary surgery was done in only 92% of pts (axillary node dissection 90%, sentinel node biopsy 1pt) and 7% had no definitive breast or axillary surgery due to local progression (3) or refusal (1). All pts received radiotherapy. Postop systemic therapy: CT in 5% of pts, ET in 65% and T in 10% of pts. Clinical complete response (CR) rate was 28%. At definitive surgery 10% of pts had no residual disease in breast or axilla and 3 pts had only DCIS present, for a pathologic (p)CR rate of 15% using MDACC criteria. Median follow-up was 24mo (1–238). Median 5y DFS was not reached for the entire population and those with a pCR vs. 26mo for pts with IBC; corresponding 5y DFS rates were 58%, 78%, and 41% respectively. Median 5y OS was for the entire population was 52mo vs. 48mo for pts with a pCR and 47mo in the IBC group; corresponding 5y OS rates were 62%, 78% and 44% respectively. Conclusions: Management of LABC in our cohort is fairly uniform and consistent with current guidelines. Local outcomes of LABC managed with PCT are in keeping with the published literature and arguably better since almost half of our cohort is represented by IBC which carries a worse prognosis. No significant financial relationships to disclose.
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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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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 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".