Biliary tract cancer (BTC) in the older adult: Complex decisions for complex patients.
Bibliographic record
Abstract
295 Background: BTC is an uncommon malignancy. Complex patient (pt) factors potentially determine treatment choices in older pts and may independently impact outcomes. Methods: Between 2000 and 2010, 133 pts aged ≥ 75 years with BTC were evaluated at Princess Margaret Hospital. Clinical and histopathological characteristics, geriatric-specific factors, and survival outcomes were studied in a retrospective analysis. Results: Median age was 79 years (range 75-93). Predominant histology was adenocarcinoma (95%). 31 pts (23%) had curative surgery, 4 (13%) had additional (neo)adjuvant chemotherapy (CT) ± radiation therapy (RT). Pathological staging included: I/II: 20 (65%); III: 6 (19%); IV: 5 (16%). 25 pts (19%) received CT ± RT alone, 4 (15%) had stage I/II and 21(84%) stage III/IV disease. 77 pts (58%) received best supportive care (BSC) alone. Radiological complete or partial response was noted for 33% of pts treated with CT [gemcitabine (gem) alone 48%; gem doublet 52%]. 24% pts discontinued CT with toxicity. Untreated pts had greater degrees of functional dependence and poorer social supports. Of those untreated, the risk of treatment was felt to outweigh potential benefit given age ± comorbidities in 17%. In 22%, the pt opted not to receive treatment. Median overall survival was 19.7 months for the surgical group, 12.3 mths for the CT ± RT group and 4.37 mths for the BSC group. Conclusions: Untreated BTC has a poor prognosis. Factors other than clinicopathological features may impact treatment decisions. Integrating geriatric assessements into the evaluation of this vulnerable patient group may help better guide treatment choices. [Table: see text] 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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".