Use of adjuvant chemotherapy (AC) and outcomes in stage II colon cancer (CC) with versus without poor prognostic features.
Bibliographic record
Abstract
338 Background: AC is frequently considered in patients (pts) with "high risk" stage II CC, defined by the presence of >/=1 poor prognostic features such as obstruction or perforation, T4 stage, <12 lymph nodes removed, positive resection margins, and lymphovascular or perineural invasion. Survival benefits associated with AC use in high risk pts remain largely unproven. Our aims were to examine patterns of AC use in stage II CC and to explore the impact of AC on survival in high vs. low risk pts. Methods: All pts with stage II CC in British Columbia from 1999 to 2008 and evaluated at 1 of 5 regional cancer centers were reviewed. Kaplan-Meier and Cox regression methods were used to correlate high vs. low risk status and receipt of AC with relapse-free (RFS), disease-specific (DSS), and overall survival (OS). Results: We identified 1,697 pts: 1,236 (73%) high risk and 461 (27%) low risk among whom 363 (29%) and 61 (13%) received AC, respectively. Individuals with high risk disease who received AC were younger (median 62 vs. 72 yrs, p<0.01) and had better performance status (ECOG 0/1 47% vs. 34%, p=0.02). For high risk pts, AC was associated with improved 5-year OS (Table). Adjusting for confounders, an OS advantage from AC persisted for high risk pts (HR 0.67, 95CI 0.52-0.86, p=0.002), with no significant RFS or DSS benefits. Subgroup analyses revealed individuals with T4 lesions had significantly improved RFS (HR 0.63, 95CI 0.42-0.95, p=0.03), DSS (HR 0.59, 95CI 0.37-0.93, p=0.03), and OS (HR 0.50, 95CI 0.33-0.77, p=0.002). For low risk pts, AC was associated with worse RFS (HR 2.27, 95CI 1.03-4.97, p=0.04) and DSS (HR 2.97, 95CI 1.10-8.02, p=0.03). Conclusions: In this population-based cohort study, AC was associated with an OS advantage in high risk pts, likely due to pt selection. RFS and DSS benefits were mainly seen in T4 lesions, suggesting a limited role for AC in pts deemed high risk. A possible trend towards harm was seen in the low risk group receiving AC. Better risk stratification schemes including those that incorporate molecular testing are warranted. [Table: see text]
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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 | 0.001 | 0.001 |
| 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) | 0.001 | 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".