A study of the association of the diagnosis to treatment initiation duration and overall survival in stage I non-small cell lung cancer treated with stereotactic body radiation therapy
Bibliographic record
Abstract
Background: Lung cancer is one of the most common cancers in the world, and the leading cause of cancer-related death in Ontario. It is clinically relevant to understand the association between the diagnosis to treatment initiation (DTI) duration and overall survival (OS) in lung cancer, yet prior studies have been limited by poor validity and inconsistent methodologies. Consensus-based recommendations were developed to address these limitations. This study aimed to apply the consensus-based recommendations to investigate the association between DTI duration and OS in stage I non-adenocarcinoma non-small cell lung cancer (NSCLC) patients who received stereotactic body radiation therapy (SBRT) in Ontario. No prior study has addressed this common lung cancer treatment. Methods: A population-based retrospective cohort study was conducted using administrative health data from ICES. The cohort included Ontario patients with pathologically diagnosed stage I NSCLC between January 1, 2010, and June 30, 2019, who received curative SBRT. Patients with adenocarcinomas were excluded from the cohort due to their heterogeneity, uncontrollable within the available data. Kaplan Meier analysis and multivariable Cox proportional hazards models were used to assess the association between DTI duration and OS. Cubic splines were used to assess the linearity of the exposure. Results: 532 patients were included in the cohort. The median DTI duration was 61 (interquartile range: 46-79) days. The Kaplan Meier analysis suggested a trend with longer DTI durations being associated with worse OS. There was no evidence to support a non-linear association between DTI duration and OS. In multivariable Cox proportional hazards models, every 1-week and 4-week increase in DTI duration was associated with a 4% (aHR = 1.04 (95% CI = 1.01-1.08 p = 0.022)) and 19% (aHR = 1.19 (95% CI = 1.03-1.38 p = 0.022)) increased rate of all-cause death respectively. Findings were robust in sensitivity analysis. Conclusions: This thesis advances the understanding of cancer DTI duration and OS, while demonstrating the effective application of the consensus-based recommendations. Longer DTI durations were associated with worse OS in stage I non-adenocarcinoma NSCLC patients who received SBRT in Ontario. These findings can inform clinical decision-making and health policy to improve patient outcomes.
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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 | 0.007 |
| 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 | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".