PS01.209: POPULATION-LEVEL SURVIVAL FOR ESOPHAGEAL CANCER: AN ANALYSIS OF 13,930 PATIENTS IN A REGIONALIZED, SINGLE-PAYER HEALTH SYSTEM
Bibliographic record
Abstract
Abstract Background Despite advances in medical and surgical treatment, esophageal cancer remains a high-fatality disease. Regionalized cancer care may improve short and long-term survival. This study defines perioperative and long-term survival for esophageal cancer on a population level. Methods A population-based retrospective cohort study in a single-payer health system (Ontario, Canada; population 13.6M) was performed using linked health administrative data. Adults diagnosed with adenocarcinoma or squamous cell esophageal and esophagogastric junction cancer between 2002–2014 were included. Thoracic surgery was regionalized to 15 centres of excellence by 2010. The Kaplan-Meier method was used to estimate median survival. Rates of perioperative mortality, defined as in-hospital and 90-day post discharge death, were calculated before and after regionalization. Multivariable logistic and Cox proportional hazards regression analyses were used to identify factors associated with short and long-term survival. Results 13,930 patients were diagnosed with esophageal cancer during the study period. Median survival was 10.1 months from date of diagnosis (95% CI 9.9–10.5), and marginally better for patients with adenocarcinoma compared to squamous cell carcinoma (10.4 vs 9.0 months, P = 0.002). Cox regression analysis showed age, socioeconomic status, and region of residence were significantly associated with long-term survival. Approximately 30% of the cohort (n = 3880) underwent curative-intent surgery and had a median survival of 24.5 months (95% CI 23.4–25.9) from the date of surgery. In these patients, age, socioeconomic status, major surgical complications and year of diagnosis were significantly associated with long-term survival (P < 0.001). Perioperative mortality decreased from 13.8% in 2002 to 5.4% in 2014 (P < 0.001). Only age and major surgical complications were associated with increased perioperative mortality (P < 0.001). Surgery at a thoracic centre reduced the odds of perioperative mortality (OR 0.63, 95% CI 0.49–0.81), but did not influence long-term survival (P = 0.79). Conclusion Median survival for patients diagnosed with esophageal cancer remains poor but is greater than two years for patients undergoing curative-intent surgery. Perioperative mortality significantly decreased over time as surgical care was regionalized to centres of excellence, but this has not affected long-term survival. Further work should analyze variation in short and long-term survival across thoracic surgery centres of excellence. Disclosure All authors have declared no conflicts of interest.
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| 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".