Absolute benefit from adjuvant chemotherapy in triple negative breast cancer (TNBC): A systemic review and meta-analysis.
Bibliographic record
Abstract
e12501 Background: In general, early stage TNBC has a poor prognosis. Adjuvant chemotherapy is the gold standard therapy and different regimens have shown improved outcome. It is uncertain whether all regimens have similar efficacy and if all patients with TNBC benefit equally from treatment. Methods: We searched PUBMED to identify randomized trials between 2007 and 2017 comparing different adjuvant chemotherapy regimens in breast cancer. Only studies reporting outcomes for patients with TNBC (or hormone receptor negative disease if data on TNBC not reported) were included. The absolute differences between the experimental and the control group for 5-year disease-free survival (DFS) and overall-survival (OS) were extracted. The absolute benefit from treatment was weighted by study sample size and pooled. We then compared differences between various generations of chemotherapy. Meta-regression analysis explored the influence of study-level median follow-up, tumor size, nodal status, median age, menopausal status and generation of chemotherapy on the benefit from adjuvant chemotherapy. Results: Nineteen studies comprising of 22 comparison groups and 11306 patients with TNBC were included in the analysis. Studies comparing chemotherapy regimens of different generations showed the largest difference in 5 year DFS (weighted mean difference 7.4% for 3rd vs. 2nd generation and 5.9% for 2nd vs. 1st generation). Studies comparing chemotherapy regimens from the same generation showed smaller differences in DFS (1.9%, 1.3% and -3.5% for studies comparing 3rd, 2nd and 1st generations, respectively). The weighted differences in 5 year OS were generally lower (0.4% to 5.8%). Meta-regression results are shown in the Table. Conclusions: Later generations of adjuvant chemotherapy result in substantially improved DFS in patients with early stage TNBC with patients with larger tumor size and nodal involvement gaining most benefit irrespective of age and menopausal status. Large differences in 5 year DFS do not translate to similar effects in 5 year OS. Variable DFS β P value Median age -0.144 0.63 Menopausal 0.374 0.21 T2-T4 0.822 0.001 Node positive 0.525 0.04 Follow-up duration -0.024 0.92
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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 | 0.010 | 0.022 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.036 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 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".