Adjuvant chemotherapy in the management of cholangiocarcinoma: A 10-year cohort analysis.
Bibliographic record
Abstract
330 Background: The evidence regarding treatment outcomes from chemotherapy for cholangiocarcinomas (CCAs) is limited because of the high mortality rate and a low overall incidence. Most studies are small and include a heterogeneous group of tumors (biliary, pancreatic, hepatocellular, and ampullary cancers) that each have a unique natural history and response to chemotherapy. The aim of this study is to assess the effect of chemotherapy on survival of patients with surgically resected (R0-negative margins/R1-positive margins) and unresectable (R2-gross residual tumor/metastatic) CCAs. Methods: In a retrospective single-center study, data on all CCA patients (n=209) from 1998 to 2008 were evaluated. Survival time was assessed as a primary outcome measure. Patient demographics, pathological diagnosis, performance status, chemo-radiation therapy, surgical resection, relapse rates and laboratory outcomes were assessed. Results: 209 cases of CCA (female n=116, mean age 65, adenocarcinoma n=166 (79.4%), stage 0/1 n=17 (8.1%), stage 2/3 n=99 (47.3%), stage 4 n=93 (44.4 %)) were identified. 162 (77.5%) patients received treatment (surgical resection n=118 (R0 n=53, R1 n=21) chemotherapy n=85, radiation therapy n=33). Median overall survival (months) was 9.8 (no treatment =2.1, treatment =12.4 (R0 and R1 surgical resection =21.9 and 10.9 p<.001). Median survival (months) in patients with surgical resection with and without adjuvant chemotherapy was 22.2 vs 21.9 p=0.75 for R0 resection and 18.1 vs 10.9 p=0.10 for R1 resection. In patients with unresectable tumor, median survival with and without chemotherapy was 10.7 and 2.1 months (p<.05) respectively. Conclusions: CCAs are associated with poor survival if untreated. Complete surgical resection was associated with significantly improved survival outcomes. Adjuvant chemotherapy in the setting of R0 resection did not improve survival compared to surgical monotherapy. In the setting of unresectable or metastatic CCA, survival was significantly prolonged in patients who received palliative chemotherapy. Although not conclusive, these data suggests the use of adjuvant chemotherapy in the setting resection with positive margins (R1) may also prolong survival.
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 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) | 0.001 | 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".