Treatment and outcomes of goblet cell adenocarcinomas (GCAs) of the appendix.
Bibliographic record
Abstract
551 Background: GCAs are rare mucinous neoplasms with mixed epithelial and endocrine differentiation, which behave more like mucinous adenocarcinomas than appendiceal neuroendocrine tumors. Optimal therapy is poorly described. Objectives of this study were to define prognostic factors and describe management of patients presenting with stage I-IV disease. Methods: Patients diagnosed with GCAs between 1990-2010 were identified from the British Columbia province-wide cancer registry and linked to an electronic pathology archive. Pathology was reviewed in 79 of 87 cases where archival tissue was available. Treatment and outcome data were obtained from the BC Cancer Agency, GI Cancer Outcomes Unit, and Provincial Pharmacy databases, combined with chart review. Kaplan Meier survival analysis was used to compare outcomes. There were insufficient events for robust multivariate analysis. Results: 87 cases of appendiceal GCAs were identified for an annual population incidence of 0.2/200,000. Median age was 54 (range 25-91) years, and 42 (48%) were male. There were no stage I patients. For stage II-III (n=68) and stage IV (n=19) patients, median overall survival (OS) was 42.8 and 15.4 months, respectively (p=0.009). Of stage II-III patients, 51 (76%) underwent right hemicolectomy and 9 (16%) received adjuvant chemotherapy: 5-FU (n=5), 5FU/oxaliplatin (n=4). Median recurrence-free survival (RFS) was 38.2 months (10 recurrences: 9 peritoneal, 1 hepatic). Univariate analysis demonstrated no prognostic effect of adjuvant chemotherapy, surgical approach (hemicolectomy vs. appendectomy), T4 tumors, number of nodes resected, or lymph node positivity. 5-year RFS was 90.2% in patients who presented with appendicitis, compared to 63.7% in those without appendicitis (p=0.016). Of 19 patients with stage IV disease, 10 (63%) received palliative chemotherapy including FOLFOX (n=4), FOLFIRI (n=1), FOLFIRI/bevacizumab (n=2), and capecitabine (n=2). Only high mitotic rate was associated with reduced OS. Conclusions: GCAs are rare tumors and the majority present with non-metastatic disease. Presentation with metastatic disease carries a poor prognosis and chemotherapy agents used for advanced colorectal tumors are most commonly applied.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 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".