Impact on relapse free survival (RFS) of time to hormone therapy (HTx) after diagnosis (Dx) of low risk hormone receptor positive (HR+) early breast cancer (BC).
Bibliographic record
Abstract
580 Background: Retrospective series show worse RFS for adjuvant chemotherapy (CTx) delay. We hypothesized the same effect for delays to HTx in low risk HR+ BC, for which CTx benefit is low. Methods: Histopathologic and demographic data were collected for all patients referred to the British Columbia Cancer Agency with a new dx of stage I or II, grade 1 or 2, HR+, HER2 negative BC from 01/2005 to 12/2009. Neoadjuvant-treated, prior or synchronous bilateral BC, no HTx prior to relapse, or > 53 weeks (w) to HTx start were excluded. RFS was calculated for three pre and postmenopausal cohorts (C), defined as 1) 0- < 20 w; 2) 20- < 34 w; 3) 34-53 w from dx to HTx, based on first prescription. Multivariable (M) analysis identified factors significant for RFS. Results: Median follow up for the 3737 cases was 6.4 years (y). 80% were stage I: 28% of C1 and 69% of C3 were stage II. 90% were strongly estrogen receptor (ER) positive. Median age was 64, 58, and 51y in C 1, 2, and 3. Most were menopausal (71%) and 23% had CTx (< 1%, 27%, and 76% of C 1, 2, 3). HTx was started < 20 w and > 34 w after dx in 57% and 15%, respectively. Five year RFS was 97.3%, 96.4%, and 95.5% for C1, 2, and 3 (p0.018). The table below shows univariate (U) and M results, M hazard ratios (Hz) and 95% confidence intervals. Conclusions: While unnecessary delays to HTx should be avoided, we did not detect a significant impact on RFS of up to 1 year delay in low stage and grade, population-based HR+ HER2 negative BCs. RFS was influenced by stage, PR level (all); grade and ER level (menopausal); and age at dx (premenopausal). If there is an impact on early RFS of HTx delay, it is likely subtle and only in premenopausal women. Our results do not exclude an impact on late RFS or in higher risk disease, or explore impact of longer delays. Menopausal Premenopausal p-value U M Hz U M Hz Time cohort 0.007 0.51 0.07 0.055 < 20 v 34+ w 0.90 (0.32, 2.54) pNS Stage I vs II < 0.0001 < 0.0001 0.24 (0.16,0.38) 0.005 0.001 0.32 (0.16,0.63) Progesterone receptor (PR) 0.003 0.0014 High vs zero 0.58 (0.35,0.99) p0.046 0.02 0.007 high vs zero 0.24 (0.10,0.58) p0.001 ER < 0.0001 0.016 high vs Low 0.21 (0.07,0.61) P0.004 0.88 Grade 1 vs 2 0.0003 0.0088 0.54 (0.34,0.86) 0.06 0.09 Age 0.77 0.04 0.022 0.94 (0.90,0.99)
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| 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) | 0.002 | 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".