This prospective single-center observational study will evaluate the concordance between recommendations generated by a locally deployed large language model and standardized multidisciplinary team recommendations for patients with rectal cancer.
Consecutive adult patients with pathologically confirmed rectal adenocarcinoma who are scheduled for routine rectal cancer multidisciplinary team discussion will be enrolled. For each case, investigators will prepare a standardized de-identified clinical summary before the multidisciplinary team meeting. The same summary will be used for large language model generation and routine multidisciplinary team discussion.
The large language model recommendation will not be disclosed to the clinical team and will not influence actual patient management. Concordance between the large language model recommendation and the multidisciplinary team reference recommendation will be assessed using predefined structured rules and blinded expert review.
Age 18 years or older.
Pathologically confirmed rectal adenocarcinoma.
Scheduled for routine rectal cancer multidisciplinary team discussion at the study center.
Availability of complete or substantially complete standardized decision-making information before multidisciplinary team discussion, including clinical, pathological, and key imaging information.
Severely incomplete clinical information preventing preparation of a standardized case summary.
Non-rectal primary tumor.
Routine follow-up cases without a defined treatment decision question.
Absence of a structured pelvic magnetic resonance imaging report meeting the requirements of the institutional rectal cancer multidisciplinary team, or missing pelvic magnetic resonance imaging elements that preclude key rectal cancer decision-making.
The study population will consist of consecutive adult patients with pathologically confirmed rectal adenocarcinoma who are scheduled for routine rectal cancer multidisciplinary team discussion at Shandong Cancer Hospital and Institute. Eligible cases must have sufficient clinical, pathological, and imaging information to allow preparation of a standardized de-identified case summary for concordance assessment between large language model-generated recommendations and multidisciplinary team reference recommendations.
Cohort
Prospective
Large Language Model Recommendation Generation
Other interventionFor each enrolled case, a standardized de-identified clinical summary will be entered into a locally deployed large language model using a fixed prompt and fixed inference parameters. The model will generate a structured treatment recommendation for concordance assessment. The large language model output will not be disclosed to the multidisciplinary team and will not influence actual patient management.
Percentage of Cases With Complete Concordance in Preferred Treatment Pathway Assessed Using a Structured Concordance Adjudication Form
Percentage of enrolled cases in which the preferred treatment pathway recommended by the large language model is completely concordant with the multidisciplinary team reference recommendation, as assessed using a predefined structured concordance adjudication form. The unit of measure is percentage of cases.
Percentage of Cases With Concordant Specific Treatment Implementation Assessed Using a Structured Concordance Adjudication Form
Percentage of cases in which the large language model recommendation and the multidisciplinary team reference recommendation are rated as concordant for the specific treatment implementation plan using a predefined structured concordance adjudication form and blinded expert review. The unit of measure is percentage of cases.
Percentage of Applicable Cases With Concordant Alternative Treatment Options Assessed Using a Structured Concordance Adjudication Form
Percentage of applicable cases in which the large language model recommendation and the multidisciplinary team reference recommendation are rated as concordant regarding acceptable alternative treatment options using a predefined structured concordance adjudication form and blinded expert review. The unit of measure is percentage of applicable cases.
Percentage of Cases With Concordant Identification of Additional Examination or Information Needs Assessed Using a Structured Concordance Adjudication Form
Percentage of cases in which the large language model recommendation and the multidisciplinary team reference recommendation agree on whether additional examinations, restaging, or key information are needed before treatment decision-making, as assessed using a predefined structured concordance adjudication form. The unit of measure is percentage of cases.
Percentage of Cases With Major Discordance Assessed by Blinded Expert Review
Percentage of enrolled cases in which differences between the large language model recommendation and the multidisciplinary team reference recommendation are classified as major discordance using a predefined structured adjudication form and blinded expert review. Major discordance is defined as a clinically substantial difference potentially associated with undertreatment, overtreatment, incorrect treatment sequencing, inappropriate organ preservation or local control judgment, or omission of necessary additional evaluation. The unit of measure is percentage of cases.
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