PROSPECT eligibility and clinical outcomes: Results from the pan-Canadian rectal cancer consortium.
Bibliographic record
Abstract
6594 Background: The current standard for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiation therapy (nCRT) followed by surgery. The PROSPECT trial (N1048) is investigating neoadjuvant FOLFOX with selective use of nCRT in patients (pts) with LARC undergoing low anterior resection (LAR). We evaluated outcomes of PROSPECT eligible and ineligible pts from a retrospective multi-institution database. Methods: Data from pts with LARC who received nCRT and had curative intent surgery from 2005 to 2014 were collected from 5 Canadian cancer centres. PROSPECT eligible pts included: cT3N0, cT2N1 and cT3N1 rectal adenocarcinoma, ECOG performance status (PS) ≤ 2, hemoglobin > 80 g/L, age > 18 years and receipt of LAR. Overall survival (OS), disease free survival (DFS), recurrence free survival (RFS), and time to local recurrence (TLR) were estimated using Kaplan-Meier method. Cox proportional hazards regression (MVA) was used to adjust for prognostic factors including circumferential resection margin (CRM), PS, clinical stage, pathological stage (ystg) and adjuvant chemotherapy (aCT), sex, age and RT dosage. Results: 1531 pts were included of whom 566 (37%) were considered eligible for PROSPECT. Eligible pts were more likely to have better PS (p = 0.0003), RT ≥ 45Gy (p = 0.001), negative CRM (p < 0.0001) and distance ≥ 5cm from anal verge (p < 0.0001). PROSPECT eligibility was associated with improved DFS (HR 0.75, 95% CI: 0.61-0.91), OS (HR 0.73, 95% CI: 0.57-0.95) and RFS (HR 0.68, 95% CI: 0.54-0.86) in univariate analyses. In MVA, RFS was improved for PROSPECT eligible pts (HR 0.75, 95% CI: 0.57 – 1.00, p = 0.0499), but not for OS and DFS. TLR was also similar (HR 0.95, 95% CI: 0.31-3.0) adjusting for CRM, ystg and aCT. The 3-year DFS for PROSPECT eligible pts was 79.1% compared with 71.1% for ineligible pts and the rate of freedom from local recurrence at 3 years was 97.4 v 96.8%, respectively. In comparison, the PROSPECT trial has estimated a 3-year DFS of 69-74% and a 3-year freedom from local recurrence of 96%. Conclusions: Real world data corroborate the eligibility criteria used in the PROSPECT study, identifying a subgroup of patients in whom recurrence risk is lower and where selective use of CRT should be actively examined.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
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".