Biochemical and imaging surveillance for Li-Fraumeni syndrome: The “Toronto Protocol” at 11 years.
Bibliographic record
Abstract
e12546 Background: Carriers of a germline TP53 mutation have a substantial lifetime risk of developing cancer. We sought to update our evaluation of a comprehensive surveillance protocol for individuals with Li-Fraumeni syndrome. Methods: A clinical surveillance protocol, utilizing frequent biochemical and imaging studies, was introduced at three tertiary care centres on January 1, 2004 for TP53 mutation carriers. We conducted a prospective observational study of individuals in 20 families who either chose to undergo surveillance or who declined surveillance. The primary outcome measure was detection of new cancers. Results: As of January 1, 2015, 46 TP53 mutation carriers were identified. Thirty-one individuals have undergone surveillance over an average period of 65 months (range 4-150 months), and 20 asymptomatic tumors have been detected in 10 patients. Two additional cancers were diagnosed between assessments. Twelve incidental findings were documented, most of which led to additional imaging and 2 of which led to a biopsy. Among the 22 patients who declined surveillance, 21 symptomatic tumors were diagnosed in 19 patients. Seven of the 19 patients not on surveillance who developed cancer are alive, compared to 8 of the 10 patients on surveillance who developed cancer. Individuals demonstrated nearly 100% compliance with the surveillance protocol. Conclusions: We demonstrate the sustained feasibility and utility of a surveillance protocol for the early detection of neoplasms in individuals with germline TP53 mutations.
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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 | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.001 |
| 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".