EP-05 * POSTERIOR FOSSA EPENDYMOMA SUBGROUPS HAVE DISTINCT THERAPEUTIC AND PROGNOSTIC IMPLICATIONS
Bibliographic record
Abstract
BACKGROUND: Recent integrated genomic studies has shown that posterior fossa ependymoma comprise two distinct molecular subgroups, termed EPN-PFA and EPN-PFB, whereby EPN-PFA are typically younger and have a worse prognosis. Current standard of care for all posterior fossa ependymoma include surgery and conformal external beam radiation to the tumour bed, irrespective of extent of resection or subgroup. We sought to delineate the prognostic implications of external beam irradiation in a subgroup specific manner. METHODS: We assembled a cohort of 365 posterior fossa ependymoma's and were subgrouped using genome wide methylation arrays. Clinical details were ascertained through a retrospective chart review. RESULTS: In a primarily pediatric cohort, 10% of cases were EPN-PFB. Five-year progression free survival in EPN-PFA cases was 0.216 +/− 0.03 and EPN-PFB cases was 0.667 +/− 0.082. Five-year overall survival in EPN-PFB cases was 1 suggesting that EPN-PFB cases benefit significantly from salvage therapies. Extent of resection was a significant predictor of poor outcome in EPN-PFA cases (p = 0.012) but not EPN-PFB (p = 0.224). Upfront external beam irradiation conferred a significant survival advantage in EPN-PFA cases, however in EPN-PFB, salvage strategies could be successfully employed in patients not receiving upfront external beam irradiation. Metastatic recurrences were enriched in the EPN-PFA group (p = 0.04). CONCLUSIONS: There are significant clinical and therapeutic differences between the two principle posterior fossa ependymoma subgroups. Extent of resection remains prognostic in EPN-PFA, although gross totally resected EPN-PFA continue to have a poor outcome compared to EPN-PFB. Careful de-escalation of therapy could be considered for older children and adolescents with EPN-PFB tumours.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".