Population-based analysis of time to palliative chemotherapy (TPC) and survival in advanced non-small cell lung cancer (NSCLC).
Bibliographic record
Abstract
e17700 Background: The time interval between surgery and adjuvant chemotherapy has been shown not to be associated with inferior survival in NSCLC patients (pts). Whether there is an association between TPC and survival in advanced NSCLC has not yet been evaluated. Methods: The British Columbia Cancer Agency (BCCA) provides comprehensive cancer care to a population of 4.5 million. All cases of stage 3b/4 NSCLC diagnosed in BC, Canada, from January to December, 2009 were identified using the BC Cancer Registry. TPC was defined as the time from diagnosis (dx) to palliative chemotherapy (PC). Logistic regression was used to evaluate factors associated with TPC of greater than 8 wks. The effect of delayed TPC and overall survival (OS) was assessed by Cox proportional hazards modeling. Results: Of the 1374 pts with advanced NSCLC identified, 748 (54%) were assessed by medical oncology (MO), and 415 (55%) received PC. The median TPC was 8 weeks (wks) (range, 1-112 wks). The only factors associated with a TPC greater than 8 wks were older age and radiation oncology consult (RO). ECOG >2 was associated with a poorer OS (HR 1.74, CI 1.4-2.2). A TPC of >8 wks was associated with a better OS (HR 0.65, CI 0.52-0.81). Conclusions: Only half of advanced NSCLC pts saw a MO, and only half received PC. More than half of pts started PC > 8 wks after diagnosis. Delayed TPC was associated with an improved OS in advanced NSCLC. This may be a function of biology of disease, with more aggressive phenotypes receiving upfront chemotherapy. TPC 1-8 wks n = 210 (51%) TPC>8 wks n = 205 (49%) p-value Sex Male Female 109 (52) 101 (48) 106 (52) 99 (48) 0.52 Age, range 63, 29-87 65, 40-87 0.01 ECOG 0-2 3-4 123 (59) 87 (42) 127 (62) 78 (38) 0.27 Geographic site Rural Urban Unknown 40 (19) 169 (81) 1 (1) 48 (23) 156 (76) 1 (1) 0.55 Histology Non-squamous Squamous Not otherwise specified 138 (66) 41 (20) 31 (15) 123 (60) 51 (25) 31 (15) 0.39 RO 164 (78) 181 (88) 0.01 Radiation (RT) 153 (73) 161 (79) 0.18 Dx to referral 8 (0-205) 15 (0-213) <0.0001 Referral to MO 14 (0-287) 25 (0-462) <0.0001 Referral to RO 15 (0-1034) 15 (0-1209) 0.34 Dx to radiation 49 (2-1050) 58 (1-1234) 0.14 Dx to CT 39 (5-56) 92 (57-692) <0.0001 RO to RT 12 (0-1034) 12 (0-445) 0.17 MO to chemo 14 (0-56) 33 (0-650) <0.0001
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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 | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".