Effects of early discontinuation of adjuvant chemotherapy (EDAC) and the timing of treatment on outcomes in patients with early-stage pancreatic cancer (ESPC): Result from a population-based retrospective cohort study.
Bibliographic record
Abstract
694 Background: Although evidence suggests that a delay in initiation of adjuvant chemotherapy (AC) results in inferior outcomes in some cancers, little is known about its detrimental effects in patients with ESPC. Moreover, it is not known if EDAC has been associated with high risk of recurrence and poor survival. The current study aims to determine association between timing and completion of AC and outcomes in ESPC. Methods: Patients with ESPC who were diagnosed from Jan 2007 to Dec 2017 and underwent complete resection in the province of Saskatchewan were examined. Kaplan Meier methods and log rank tests were performed for survival analyses. Cox proportional multivariate analyses were performed for correlation with recurrence and survival. Results: A total 168 patients with ESPC were identified. 97 (57%) patients were excluded as they did not receive AC, were found to have metastatic disease, did not have curative surgery or had received preoperative chemotherapy. Of 71 eligible patients with median age of 69 years (IQR: 57-73), 52% were male, 31% had WHO performance status of 0 and 92% had a comorbid illness. 78% had pancreatic head tumor, 66% had T3 tumor and 63% had node-positive disease. Median time to start of AC from surgery was 73 days (IQR: 59-89). 32% were started AC within 60 days of surgery. 89% received single-agent chemotherapy and 25% received adjuvant radiation. 69% completed planned treatment. Median time to recurrence in group which completed treatment was 22 months (95%CI:15.8-28.2) vs. 9 months (3.3-14.7) if treatment was discontinued early (P < 0.001). Median overall survival of the group that completed treatment was 33 months (17.5-48.5) vs. 16 months (17.5-48.5) if it was stopped early (P < 0.001). On multivariate analysis, EDAC was significantly correlated with recurrent disease (HR = 3.0; 1.6-5.5), P = 0.0001 and inferior survival (HR = 3.2; 1.68-6.12), P < 0.001. No correlation between AC timing and survival was noted. Conclusions: Although timing of AC does not correlate with inferior outcomes, EDAC has been associated with high risk of recurrence and inferior survival in ESPC.
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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 | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| 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".