Clinical outcomes of elderly patients receiving neoadjuvant chemoradiation for locally advanced rectal cancer.
Bibliographic record
Abstract
6516 Background: There are limited studies assessing the outcomes of elderly patients treated with neoadjuvant chemoradiation (nCRT) for locally advanced rectal cancer. Our aim was to assess the impact of age on clinical outcomes in a large multi-institutional database. Methods: Data from patients across Canada with locally advanced rectal cancer who received nCRT and had curative intent surgery from 2005 to 2012 were collected from Tom Baker Cancer Center, Cross Cancer Institute, BC Cancer Agency, Ottawa Hospital Cancer Centre and Dr. H. Bliss Murphy Cancer Centre. Age was analyzed as both a continuous and a dichotomous variable (<70 v ≥ 70 yrs) and correlated with time free of recurrence (TFR where death without recurrence is censored), disease free survival (DFS), and overall survival (OS). Multivariable analyses (MVA) controlled for sex, ECOG, circumferential resection margins, radiation dose, distance from anal verge, pre-treatment anemia, clinical stage, pathologic stage and completion of neoadjuvant chemotherapy. Results: A total of 1,172 patients were included with a mean age of 62 years (SE±0.33) and a mean follow-up of 3.8 yrs (SE±0.05). Among them, 295 (25%) patients were ≥ 70 years. Elderly patients were less likely to receive adjuvant chemotherapy (ACT) (57% v 77%, p<0.0001), oxaliplatin-based ACT (12% v 31%, p<0.0001). They were also less likely to complete neoadjuvant chemotherapy (76% v 86%, p<0.001) but more likely to be anemic at initiation of nCRT (42% v 31%, p=0.0004). In the MVA, elderly patients had improved TFR (HR 0.65, 95% CI 0.45 – 0.95, p = 0.02), similar DFS (HR 0.928, 95% CI 0.68 – 1.26, p = 0.63) and similar OS (HR 1.28, 95% CI 0.88 – 1.86, p =0.2) compared to younger patients. As a continuous variable, age was not significantly associated with TFR (HR 0.99, 95% CI 0.98 – 1.01, p = 0.47) or DFS (HR 1.00 95% CI 0.99 – 1.02, p =0.49). However, it was significantly associated with inferior OS (HR 1.02, 95% CI 1.00 – 1.03, p =0.04) in the MVA. Conclusions: Elderly patients (≥ 70 yrs) who receive nCRT followed by surgery appear to have similar cancer related outcomes compared to younger patients. Decisions regarding eligibility for nCRT and surgery should not be based on age alone.
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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 | 0.000 | 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".