Long-term survival following trimodality therapy vs. medical management of malignant pleural mesothelioma.
Bibliographic record
Abstract
8560 Background: Medical management based on palliative chemotherapy is currently the standard of care in malignant pleural mesothelioma (MPM). Median survival of 12-16 months has been reported with modern chemotherapy regimens. Multimodality therapy incorporating radical surgery, systemic chemotherapy and radiotherapy has recently evolved. The MARS feasibility study suggested that extrapleural pneumonectomy might be detrimental, but recent publications suggested that pleurectomy/decortication (P/D) may lead to better outcomes with overall median survival of 30-35 months in selected patients. Retrospective studies comparing trimodality therapy vs. medical management conducted in centers where surgery is offered are obviously limited by selection bias. Our objective was to compare overall survival in patients offered trimodality therapy at a single institution to the one of patients treated at another institution where the management of MPM is exclusively medical. Methods: Retrospective analysis of two databases: 106 consecutive patients (cohort 1) treated by a single team in London (UK) from 2009 to 2016 and 98 consecutive patients (cohort 2) exclusively treated medically at the Quebec Heart and Lung Institute (Canada) during the same period were included. Results: In cohort 1, all patients had P/D with hyperthermic pleural lavage with povidone-iodine, prophylactic chest wall radiotherapy and systemic chemotherapy. In cohort 2, 51% received palliative care only; 31% were treated with chemotherapy. Median survival was 32 months vs 10 months in cohort 1 and 2, respectively (hazard ratio with age, gender, pathology and TNM staging as covariates: 3.81; 95% CI: 2.66 – 5.45; p < 0.0001). Conclusions: Aggressive therapy of MPM using cancer-directed surgery, systemic chemotherapy and prophylactic radiotherapy may provide a significant survival benefit in selected patients. Trimodality therapy (n = 106) Medical therapy (n = 98) P Age (mean ± SD) 64 ± 2 70 ± 5 < 0.0001 Gender (n, % male) 83 (78%) 73 (74%) 0.16 Pathology (n, %) < 0.0001 Epithelioid 73 (69%) 57 (58%) Sarcomatoid 2 (2%) 15 (15%) Biphasic 31 (29%) 21 (21%) Unknown 0 5 (5%) Staging (n, %) 0.0005 1 -2 22 (21%) 43 (44%) 3 – 4 84 (79%) 55 (56%)
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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 | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| 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".