A Population-Based Cohort Study of Glioblastoma (World Health Organization Grade 4 Gliomas) in Ontario: Continued Improvement in Care over 25 Years
Bibliographic record
Abstract
OBJECTIVE: Grade 4 glioma is the most common and fatal primary malignant brain tumor in adults. We sought to describe the evolution of care and survival of patients with glioblastoma in a single-payer Canadian provincial health care system over a 24-year period. METHODS: Adult patients >18 years old with pathologically or clinically diagnosed glioblastoma (based on fourth or earlier edition of World Health Organization classification) in Ontario between 1994 and 2018 were identified and followed until death or study end point of 2 years through provincial administrative health data. Patient characteristics, type of treatment, survival, and time spent in the hospital were compared across time periods, age groups, and centers. RESULTS: We included 9487 patients with glioblastoma treated from 1994 to 2018. Median survival and 2-year survival rate improved over the study period from 6.4 to 9.4 months and 10% to 18%, respectively. Older age was associated with shorter survival (median survival of 12 months at 65-74 years vs. 3 months at > 85 years), less aggressive therapy, and a higher proportion of remaining lifetime spent in the hospital (more than one third of patients >75 years spend ≥50% their remaining survival in hospital). Time in the hospital decreased by 8.9 days (95% confidence interval 8.53-9.25) over the study period. Significant heterogeneity exists in patient management and outcome between regional treatment centers. CONCLUSIONS: The real-world prognosis for grade 4 glioma remains poor. However, an increased proportion of patients receiving maximal therapy is associated with a small but meaningful improvement in survival and decreased time in the hospital for all but the oldest patients.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| 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) | 0.000 | 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 teacher head, 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".