Investigating extrathoracic metastatic disease in patients with apparently operable lung cancer. The Canadian Lung Oncology Group.
Bibliographic record
Abstract
BACKGROUND: The optimal approach to the investigation of possible distant metastases in patients with apparently operable non-small cell lung cancer who do not have symptoms suggesting metastatic disease is controversial. METHODS: We conducted a randomized, controlled trial in thoracic surgery services at mainly academic tertiary- and secondary-care general hospitals. We recruited 634 patients with apparently operable, suspected or proven non-small cell carcinoma of the lung without findings on history, physical examination, laboratory testing, or imaging suggesting extrathoracic metastases. Patients were randomly allocated to receive either mediastinoscopy and computed tomography of the chest and then, depending on the results, immediate thoracotomy or bone scintigraphy and computed tomographic scanning of the head, liver, and adrenal glands. RESULTS: The relative risk of thoracotomy without cure (the combination of open and closed thoracotomy, incomplete resection, and thoracotomy with subsequent recurrence) in the full investigation group versus the limited investigation group was 0.80 (95% confidence interval [CI], 0.56 to 1.13; p = 0.20). Forty-three patients in the full investigation group and 61 patients in the limited investigation group underwent a thoracotomy but subsequently had recurrence (relative risk, 0.70; 95% CI, 0.47 to 1.03; p = 0.07). Patients in the full investigation group were more likely to have avoided thoracotomy because of extrathoracic metastatic disease than those in the limited investigation group (22 patients versus 10 patients, respectively; relative risk, 2.19; 95% CI, 1.04 to 4.59; p value = 0.04). The total number of negative invasive tests was six in the full investigation group and one in the limited investigation group (relative risk, 6.1; 95% CI, 0.72 to 51.0; p = 0.10) and the total number of invasive tests, 11 versus six, respectively (relative risk, 1.84; 95% CI, 0.68 to 4.98; p = 0.23). The full investigation strategy cost $823 less per patient (95% CIs 2,482 to -725). CONCLUSIONS: Full investigation for metastatic disease in patients with non-small cell lung cancer without symptoms or signs of metastatic disease may reduce the number of thoracotomies without cure. The higher the threshold for considering symptoms to suggest metastatic disease, the more likely it is that investigation will spare patients futile thoracotomy.
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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 | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| 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".