Prognostic role of pretreatment plasma EBV DNA on stage III nasopharyngeal carcinoma staged by AJCC/UICC 8<sup>th</sup> edition TNM staging classification.
Bibliographic record
Abstract
6055 Background: The AJCC/UICC 8th edition TNM staging classification for nasopharyngeal carcinoma (NPC) was launched in 2018. We previously proposed new stage groups which incorporated pretreatment plasma EBV DNA and T-, N-classifications into recursive partitioning analysis. Stage III disease remains heterogeneous with different combinations of T and N-classifications. We investigated if pretreatment plasma EBV DNA can stratify stage III into high-risk vs. low-risk groups (NCT02476669). Methods: 518 patients with non-metastatic NPC confirmed by PET-CT and MRI scans were prospectively recruited from 2010 to 2016. They all had plasma EBV DNA measured at baseline, and then 8 weeks and 6 months following IMRT with/without concurrent +/- adjunct chemotherapy. They were treated based on 7th edition TNM but were re-staged by 8th edition TNM for subsequent analysis. Covariates including age, sex, ACE-27, pretreatment LDH and plasma EBV DNA were analyzed by Cox regression for prognostic factors of progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS). Results: 234 (45.2%) patients had stage III disease (see Table). 11 (4.7%) patients received IMRT alone, 39 (16.7%) received concurrent chemoradiation alone and the remaining 184 (78.6%) received concurrent chemoradiation and adjunct chemotherapy. The median pretreatment plasma EBV DNA was 494 copies/ml (range 0-175000 copies/ml). After a median follow-up of 5.2 years, 5-year PFS, CSS and OS in this cohort were 77.1%, 90.4% and 84.4% respectively. Pretreatment plasma EBV DNA 500 copies/ml stratified patients into high-risk vs. low-risk groups (PFS: 88.9% vs. 68.2%, p = 0.009; CSS: 96.8% vs. 85.4%, p = 0.033; OS: 91.2% vs. 79.4%, p = 0.124). Cox regression with multivariable analyses demonstrated that pretreatment plasma EBV DNA 500 copies/ml was the only significant prognostic factor of PFS (p = 0.005) and CSS (p = 0.027) while no prognostic factor was found for OS. Conclusions: Patients with high pretreatment plasma EBV DNA had a higher risk of relapse and additional therapy may be necessitated. N0 N1 N2 Total T1 0 0 43 43 T2 0 0 18 18 T3 21 46 106 173 Total 21 46 167 234
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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 | 0.000 | 0.001 |
| 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".