Prognostic Risk Score From a Multicenter Cohort of Patients With T1b Esophageal Adenocarcinoma: 2017 Presidential Poster Award
Bibliographic record
Abstract
Introduction: Limited data exist on predicting clinical outcomes in patients with submucosal (T1b) adenocarcinoma (EA). Histological features such as submucosal depth of invasion, lympho-vascular invasion (LVI), grade of differentiation and presence of lymph node metastasis (LNM) are proposed as prognostic variables. However the integration of these variables into a clinically applicable risk score is lacking. We aimed to assess the utility of a prognostic risk score (composed of the above metrics) in assessing overall survival of patients with T1b EA treated endoscopically and surgically, using a multicenter cohort. Methods: Patients diagnosed between 2001 and 2016 with esophageal adenocarcinoma invading into but not past the submucosa (T1b) from three tertiary care centers were identified. Patients were divided into two groups: endoscopically managed (Group A) and surgically managed (with or without prior EMR, Group B). All histology was read by expert gastrointestinal pathologists. A risk score consisting of presence of LVI (yes=1/no=0), grade of differentiation (well-mod=0, poor=1), EMR deep margin positivity (yes=1, no=0) for Group 1 was created. The latter was replaced with lymph node metastasis (yes=1, no=0) in Group B. Each variable was equally weighted. Four groups: each with risk score 0, 1, 2 and 3 were created in the endoscopic and surgical cohorts. Time to event analysis was conducted to assess association of the prognostic score with overall survival. Results: 191 patients, of whom 74 were treated endoscopically and 117 were treated surgically, were included. Baseline characteristics and outcomes for the four groups (scores 0-3) are listed in Tables 1 (endoscopic cohort) and 2 (surgical cohort), respectively. In the endoscopic group 25 (36.8%) underwent endoscopic ablation following EMR. 54.1%, 29.7%, and 24.4% achieved cancer (two consecutive endoscopies without cancer), dysplasia and metaplasia remission, respectively (Figures 2a & 2b), with the best overall survival in the lowest risk group (risk score=0) and the worst overall survival in the highest risk group (risk score=3).Figure: Kaplan Meier Overall Survival - Surgical Cohort (key: numerical value of histological risk score).Table: Table. Baseline demographic and outcomes of surgical cohortConclusion: A prognostic risk score incorporating histological variables and LNM is able to predict survival in T1b EA patients treated endoscopically or surgically. If further validated, patients with low risk scores may be managed endoscopically with acceptable outcomes.Figure: Kaplan Meier Overall Survival - Endoscopic Cohort (key: numerical value of histological risk score).Figure: Baseline demographic and outcomes of endoscopic cohort
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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 | 0.000 |
| 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) | 0.003 | 0.001 |
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".