Impact of age and frailty on survival in older adults with squamous cell carcinoma of the anus.
Bibliographic record
Abstract
786 Background: Patients with anal cancer (AC) can achieve long-term disease control with chemoradiation (CRT), however, the treatment has serious adverse effects. Most patients with AC are ≥65 but little is known about cancer outcomes in this population. Frailty measures have been proposed to determine the risk of treating older adults. The purpose of this study was to evaluate the impact of age and frailty on outcomes in patients with AC. Methods: A retrospective review was performed of patients age ≥65 with non-metastatic AC treated from 2007-2016 at Princess Margaret Cancer Centre. A 44-item Cumulative Deficit Score was constructed to quantify frailty as per the Rockwood model. The impact of age and frailty on treatment toxicity and overall survival (OS) was analyzed using multivariable logistic regression and survival models, respectively, adjusting for ECOG performance status (PS), stage and treatment modality. Results: Among 92 patients, median age was 72 and 42.4% were age ≥75. Seventy (76.1%) patients were treated with CRT and 17 with radical radiotherapy (RT). After a median follow-up of 34.9 mo (range 0.5-103.9) 34 patients died – 16 from metastatic AC, 16 from other or unknown causes, and 2 treatment-related deaths. For patients treated with CRT or RT (N = 87), 53 (60.9%) required treatment modification due to toxicity. Twenty patients (22.9%) had an emergency room visit or hospitalization. Frailty did not significantly increase the risk of toxicity in multivariable analysis (OR 1.9, 95% CI 0.35-10.8). Treatment with CRT increased the risk of toxicity compared to RT alone (OR 9.5, 95% CI 1.7-53.8). Patients ≥75 had shorter OS on univariable analysis (HR 1.9, 95% CI 1.0-3.8) but not on multivariable modeling (HR 1.5, 95% CI 0.72-3.4). Factors associated with shorter OS were increased frailty (HR 3.8 CI 1.4-10.2) and ECOG ≥2 (HR 3.9, 95% CI 1.7-9.1). There was good discrimination of the model with a C-statistic of 0.77. Conclusions: Older adults with AC experience a high rate of treatment toxicity especially with CRT relative to RT alone. OS was significantly associated with frailty as well as PS but not age. Frailty assessment may improve treatment planning and understanding survival for older patients with AC.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| 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) | 0.001 | 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".