Pulmonary toxicity in children, adolescents, and young adults with testicular germ cell tumors: A population‐based retrospective matched cohort study
Bibliographic record
Abstract
While testicular germ cell tumors (TGCT) are highly curable, survivors experience toxicities. Pulmonary outcomes post-TGCT are not well understood, particularly among children, adolescents, and young adults (CAYA). Using provincial cancer registries, we identified all CAYA (aged 11-21 years) diagnosed with a TGCT from 1992 to 2021 in Ontario, Canada, and matched them (1:5) to general population males (controls). We linked CAYA to health administrative databases to identify pulmonary disease and pulmonary disease healthcare visits (PDV) and classified PDV severity as low (outpatient family physician/pediatrician), medium (outpatient respirologist/internist), or high (hospitalization/emergency department). We assessed acute (<5 years from diagnosis) and late (≥5 years after diagnosis) toxicities using the cumulative incidence function and cause-specific hazard models. We identified 748 patients (404 chemotherapy-treated) and 3740 controls. Patients' median age at diagnosis was 19.0 years [interquartile range (IQR):18.0-21.0] and 29.7 years (IQR:25.0-37.6) at end of follow-up. Non-chemotherapy-treated patients had higher risk of acute toxicities (obstructive lung disease, medium severity PDV, hospitalizations) but similar risk of late toxicities to controls. Chemotherapy-treated patients had higher risk than controls of most acute pulmonary toxicities (except asthma and low severity PDV) and several late toxicities: asthma [hazard ratio (HR) = 2.0, 95%CI:1.1-3.8], pulmonary embolism/infarction (HR = 7.3, 95%CI:1.2-44.3), medium severity PDV (HR = 3.9, 95%CI:2.1-7.3), and high severity PDV (HR = 1.7, 95%CI:1.0-2.8), particularly hospitalizations (HR = 4.1, 95%CI:1.7-9.5). CAYA TGCT survivors treated with chemotherapy are at risk for late asthma, pulmonary embolism, pulmonary fibrosis, and specialist and hospital-based pulmonary care. Further follow-up is needed to characterize late pulmonary outcomes as survivors age.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| 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".