Cross-Source Progression Assessment in Advanced Pancreatic Cancer: An Opportunity-Adjusted Six-State Analysis
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PURPOSE
Radiology and treating-oncologist documentation are recorded on different schedules in routine oncology care. We characterized the opposite clinical source at its first evaluable opportunity after radiology- or medical-oncology-documented progression in advanced pancreatic cancer using an exhaustive six-state framework.
METHODS
We performed a retrospective secondary analysis of AACR Project GENIE BPC PANC v1.0-public. Patients entered the treatment-index cohort at the first systemic regimen initiated on or after advanced-disease onset. Process T0 was the first genuine radiology- or medical-oncology-documented progression after cohort entry and not after subsequent same-cancer treatment or death. The opposite source’s first evaluable opportunity was classified as same-day concordance, confirmation, explicit nonprogression, mixed, indeterminate, or no evaluable opportunity. The secondary estimand was explicit nonprogression among first opportunities classifiable specifically as progression or explicit nonprogression.
RESULTS
Of 1,109 patients, 882 entered the treatment-index cohort and 645 qualified for the primary estimand. States were same-day concordance in 25 (3.88%), confirmation in 219 (33.95%), explicit nonprogression in 108 (16.74%), mixed in 19 (2.95%), indeterminate in 166 (25.74%), and no evaluable opportunity in 108 (16.74%). Among 327 progression/nonprogression-classifiable first opportunities, 108 (33.03%; 95% CI, 28.15%-38.30%) documented explicit nonprogression. Opposite-source opportunity occurred after 88.47% of imaging-first events at a median of 5 days versus 62.94% of medical-oncology-first events at a median of 38 days. A known-regimen-completion sensitivity yielded 84/144 (58.33%).
CONCLUSION
Cross-source progression assessment frequently did not yield immediate confirmation and often remained indeterminate or unevaluable. An opportunity-adjusted six-state framework makes observation-process and clinical-boundary dependencies explicit rather than compressing them into a binary discordance estimate.
