Is neoadjuvant chemotherapy a realistic alternative to primary surgery for women with advanced ovarian cancer?
Bibliographic record
Abstract
5043 Background: To compare progression free survival (PFS) and overall survival (OS) of women with advanced ovarian cancer treated with neoadjuvant chemotherapy followed by surgery to women treated with primary surgery. Methods: A retrospective analysis of 106 patients with advanced ovarian cancer was performed. Fifty women with advanced ovarian cancer diagnosed by CT scan and positive cytologic received carboplatin and paclitaxel. Most patients selected had stage IV disease (pleural effusions) or medical comorbidities. Thirty-six patients subsequently underwent cytoreductive surgery and further chemotherapy postoperative. The OS and PFS were compared to 66 women with advanced ovarian cancer who were treated conventionally with primary cytoreductive surgery followed by 6 cycles of carboplatin and paclitaxel chemotherapy. Survival analysis was also performed on a subset data, which had been selected to be comparable for stage and grade. Results: No statistical difference was observed in OS (p=0.34, HR=1.31, CI=0.76–2.55) or in PFS (p=0.30, HR=1.31, CI=0.79–2.18) between the neoadjuvant chemotherapy group and the conventional primary surgery group. Due to the small numbers, age, grade, stage, and histologic cell type were controlled for separately in bi-variate analyses and did not change the above HR's. Survival analysis matched on stage and grade controlling for age (N=28 matched pairs) also resulted in no statistical difference for OS (p=0.95, HR=1.04, CI=0.33–3.30) and PFS (p=0.79, HR=1.11,CI=0.51–2.46). The neoadjuvant chemotherapy group had less residual disease with < 1 cm at the time of surgery compared with the primary surgical group (p=0.001) and less extensive bowel surgery was performed in the neoadjuvant chemotherapy group but did not reach statistical significance (p=0.15). Conclusion: Neoadjuvant chemotherapy followed by optimal debulking surgery may be a safe alternative in women with advanced ovarian cancer. Neoadjuvant chemotherapy did not change the OS and PFS. The role of neoadjuvant chemotherapy in advanced ovarian cancer is currently being tested in larger, prospective randomized controlled trials. No significant financial relationships to disclose.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Empirical About the Canadian research system: no · About a Canadian topic: no | Observational | low |
| gpt | no category Domain: not available · Genre: Commentary About the Canadian research system: no · About a Canadian topic: no | Other design | medium |
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 | 0.000 | 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) | 0.003 | 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, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
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".