Do patients with recurrent and de novo metastatic biliary cancer have similar outcomes on treatment
Bibliographic record
Abstract
Background: Biliary tract cancers (BTCs) include cholangiocarcinoma, referring to cancers arising in the intrahepatic, perihilar or distal biliary tree, ampulla of vater and gallbladder carcinoma. Even after complete surgical resection, a large number of patients with BTC develop recurrence. Whether recurrence after surgery and de novo metastatic BTC should have comparable stratification in first-line palliative systemic therapy studies is unknown. Methods: Patients who received palliative chemotherapy as first-line treatment for advanced BTC between January 1987 and May 2014 in Princess Margaret Cancer Centre, Toronto were reviewed. Probability of overall survival (OS) was estimated using the Kaplan- Meier method, and independent prognostic factors for OS were identified using the multivariable Cox-proportional hazard model. Results: There were 171 patients with recurrent and 309 with de novo metastatic disease. Median age at diagnosis was 62 years; performance status<2: 436 (91%) patients, male: 262 (55%). In the recurrent group, 102 (60%) had indwelling stents, 33 (32%) ampulla of vater, 14 (14%) gallbladder, 55 (54%) cholangiocarcinoma. In the de novo metastatic group, 173 (56%) had indwelling stents, primary site was ampulla of vater in 13 (7%), gallbladder in 43 (25%), cholangiocarcinoma in 117 (68%). Systemic treatment received was gemcitabine/platinum doublet in 137 (29%), gemcitabine/5- fluorouracil doublet; 186 (39%), gemcitabine; 93 (19%), other; 64 (13%). Median OS for the recurrent group who received firstline palliative chemotherapy was 15.6 months (95%-confidence interval [CI] 13.5-18.0) and 14.4 months (95%-CI 12.0-16.0) in the de novo metastatic group. Multivariable analysis for OS revealed that gallbladder as the primary site (P=0.04) and ECOG performance status ≥ 2 (P=0.001) were prognostic for worse OS. De novo metastatic status was not prognostic for worse OS compared with recurrent status (Hazard ratio 0.9, 95% CI-0.66-1.23, P=0.51). Conclusions: Similar treatment of patients with recurrent disease after surgery and de novo metastatic BTC, with first-line palliative chemotherapy is acceptable.
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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".