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Fallopian Tube Clear Cell Adenocarcinoma Phase 3 Time-to-Event Analysis NCT00108745

Paclitaxel, Polyglutamate Paclitaxel, or Observation in Treating Patients With Stage III or Stage IV Ovarian Epithelial, Peritoneal Cancer, or Fallopian Tube Cancer: Complete Statistical Analysis

This analysis examines a randomized phase III trial of paclitaxel poliglumex, paclitaxel, and observation after complete clinical response to primary platinum/taxane chemotherapy for advanced ovarian, primary peritoneal, or fallopian tube cancer. The primary outcome is overall survival, reported as median months with 95% confidence intervals.

Trial start: 2005-03-21  ·  Enrollment: 1157  ·  Sponsor: GOG Foundation
Scope of this record

This page provides an independent statistical analysis and educational interpretation of publicly reported results. ClinicalTrials.gov provides the official trial registry record. Numerical trial results on this page are restricted to the results posted in the ClinicalTrials.gov record; calculations added by Clinical Biostats are labelled as such.

1. Trial at a Glance

This page covers the registry results for Paclitaxel, Polyglutamate Paclitaxel, or Observation in Treating Patients With Stage III or Stage IV Ovarian Epithelial, Peritoneal Cancer, or Fallopian Tube Cancer (NCT00108745), a randomized phase 3 study. The primary outcome is Overall Survival.

1157
Enrollment
Phase 3
3
Arms
In the primary outcome
n/a
Effect
No re-analysis shown
n/a
95% CI
See limitations
FeatureRegistry value
ClinicalTrials.gov identifierNCT00108745
PhasePhase 3
ConditionFallopian Tube Clear Cell Adenocarcinoma, Fallopian Tube Endometrioid Adenocarcinoma, Fallopian Tube Mucinous Adenocarcinoma
AllocationRandomized
Design modelParallel
MaskingNone (open label)
Enrollment1157
Arms in the primary outcome3
Lead sponsorGOG Foundation
Results postedYes

2. Clinical Question

Population

Women with stage III or stage IV ovarian, primary peritoneal, or fallopian tube cancer who achieved a complete clinical response to primary platinum/taxane chemotherapy. The registry lists a range of ovarian and fallopian tube histologies and stage categories. The primary outcome population is all randomized participants.

Intervention

One group received paclitaxel poliglumex intravenously on day 1, with treatment repeated every 28 days for up to 12 courses unless disease progression or unacceptable toxicity occurred. A second treatment group received paclitaxel intravenously on day 1, also repeated every 28 days for up to 12 courses unless progression or unacceptable toxicity occurred.

Comparator

The observation group received no further anticancer treatment until evidence of disease progression. This is a comparison of maintenance chemotherapy strategies with observation after response to primary chemotherapy, not a comparison of initial cancer treatment.

Primary question

The primary outcome asks how long participants lived after enrollment, regardless of cause of death. The registry reports median overall survival and 95% confidence intervals for each randomized group. It does not report a hazard ratio or a statistical test comparing the groups, so the posted medians and intervals describe the group results but do not by themselves establish whether the groups differed statistically.

3. Trial Design

This was a randomized, phase III, parallel-group trial with no masking. The registry reports enrollment of 1157. The primary outcome population is all randomized participants. The three reported groups were paclitaxel poliglumex, with 387 participants; paclitaxel, with 384 participants; and observation, with 386 participants. These are the group counts shown for the primary outcome.

Participants had advanced ovarian epithelial, primary peritoneal, or fallopian tube cancer and had achieved a complete clinical response to primary platinum/taxane chemotherapy. The registry lists stage III and stage IV disease, alongside several histological categories. Its brief description frames the study as a comparison of maintenance paclitaxel, polyglutamate paclitaxel, and observation after response to initial treatment.

For the paclitaxel poliglumex group, treatment was given intravenously over 10–20 minutes on day 1 and repeated every 28 days for up to 12 courses, unless progression or unacceptable toxicity occurred. The paclitaxel group received the drug intravenously over 3 hours on day 1, on the same repeat schedule and subject to the same stated stopping conditions. The observation group received no further anticancer treatment until evidence of progression.

Follow-up for overall survival was described as physical exams and histories every three months for the first two years, then every six months for the next three years, and then annually for the next five years. The registry lists a start date of 2005-03-21 and a primary completion date of 2015-02-03. The overall status is recorded as UNKNOWN. Details such as concealment of allocation and the statistical analysis plan are not reported in the registry record.

4. Participant Flow and Accounting

The registry reports how participants moved through each stage of the study. All counts below are exactly as posted; missing counts are not inferred from other stages.

Overall Study

StageArm I (Paclitaxel Poliglumex)Arm II (Paclitaxel)Arm III (Observation)
STARTED387384386
COMPLETED353349349
NOT COMPLETED343537

Reasons for not completing this period:

ReasonArm I (Paclitaxel Poliglumex)Arm II (Paclitaxel)Arm III (Observation)
Withdrawal by Subject191212
Never Treated81012
Ineligible71313

Analysis population for the primary outcome, as defined in the registry: All randomized

5. Baseline Characteristics

The table reproduces the baseline characteristics posted in the registry, which describe the participants analysed at baseline and help show whether the randomized groups were comparable.

Population: All enrolled patients.

CharacteristicUnitArm I (Paclitaxel Poliglumex)Arm II (Paclitaxel)Arm III (Observation)Total
Participants analysed3873843861157
Age, Continuousyears59.02 (SD 10.89)58.80 (SD 10.42)59.07 (SD 9.68)58.96 (SD 10.34)
Age, Customized: < 40 yearsParticipants21131145
Age, Customized: 40 - 49 yearsParticipants547157182
Age, Customized: 50 - 59 yearsParticipants115114138367
Age, Customized: 60 - 69 yearsParticipants137132126395
Age, Customized: 70 - 79 yearsParticipants564649151
Age, Customized: >= 80 yearsParticipants48517
Sex: Female, Male: FemaleParticipants3873843861157
Sex: Female, Male: MaleParticipants0000
Ethnicity (NIH/OMB): Hispanic or LatinoParticipants18251659
Ethnicity (NIH/OMB): Not Hispanic or LatinoParticipants3413383461025
Ethnicity (NIH/OMB): Unknown or Not ReportedParticipants28212473
Race (NIH/OMB): American Indian or Alaska NativeParticipants1315
Race (NIH/OMB): AsianParticipants711927
Race (NIH/OMB): Native Hawaiian or Other Pacific IslanderParticipants1113
Race (NIH/OMB): Black or African AmericanParticipants21131751
Race (NIH/OMB): WhiteParticipants3533523551060
Race (NIH/OMB): More than one raceParticipants0000
Race (NIH/OMB): Unknown or Not ReportedParticipants44311

6. Primary Endpoint

The registry lists the primary outcome as Overall Survival, measured over All patients were followed (with physical exams and histories) every three months for the first two years, then every six months for the next three years and then annually for the next five years..

ElementRegistry entry
Result typeMedian
Measure of spread95% Confidence Interval
UnitMonths
Endpoint classificationTime-to-Event Analysis

Overall survival measures the time from study enrollment until death from any cause. The registry reports it in months and summarizes it with the median: the point by which half of the observed survival times are at or below that time and half are at or above it, as estimated by the survival analysis. A median is a description of the timing of events, not a statement about the survival experience of every participant.

Participants still alive at their last follow-up were censored on the date of their last contact. Censoring allows survival analysis to incorporate information from participants whose eventual time of death was not observed during follow-up. It does not mean that their later survival time is known. The registry describes follow-up by scheduled visits over time, but does not report the completeness of follow-up or the amount of missing outcome information.

Overall survival is a time-to-event endpoint that captures deaths from any cause rather than only deaths attributed to the cancer. The registry gives a median and a 95% confidence interval for each group. The reported medians are 60.0 months for paclitaxel poliglumex, 56.8 months for paclitaxel, and 58.3 months for observation. Their respective 95% confidence intervals are 51.7 to 68.6 months, 47.3 to 65.9 months, and 51.9 to 72.5 months. These estimates describe the groups; a direct inferential comparison is not reported in the registry record.

7. Why No Re-analysis Is Shown

Reported as posted, not recalculated. Values missing or not estimable for a two-arm comparison (median time endpoint). A result is recalculated only when the posted data support a clean two-arm comparison, so no result is shown beyond what the sponsor posted.

8. Statistical Interpretation

Clinical Biostats interpretation

The registry reports median overall survival of 60.0 months in the paclitaxel poliglumex group, 56.8 months in the paclitaxel group, and 58.3 months in the observation group. The associated 95% confidence intervals are 51.7 to 68.6 months, 47.3 to 65.9 months, and 51.9 to 72.5 months, respectively. These are group-level estimates of time from enrollment to death from any cause, with participants still alive at last contact censored at that contact.

The intervals overlap. In general, a confidence interval conveys uncertainty around an estimated quantity under the method used to calculate it. It is not a range containing the survival time of every participant, and overlap between intervals is not a substitute for a formal comparison. The registry does not report a hazard ratio, a test statistic, or a p-value for the primary outcome. It also reports no analyses in the posted results. Therefore, the medians and confidence intervals alone cannot establish whether any observed difference between groups is statistically distinguishable from chance under a specified comparison procedure.

The primary endpoint is defined consistently across the groups, and all randomized participants are identified as the outcome population. The reported group counts for this outcome are 387, 384, and 386. The counts describe the analysis listings; they do not show how many participants had complete follow-up at every scheduled visit. The outcome definition accounts for participants alive at last follow-up through censoring, but further details about the censoring distribution, loss to follow-up, or sensitivity analyses are not reported in the registry record.

The clinical question is about maintenance treatment after a complete clinical response to primary platinum/taxane chemotherapy. The observation group is described as receiving no further anticancer treatment until evidence of progression. Thus, the outcome summaries concern the strategies within this particular post-response setting. They should not be read as results for initial treatment, for disease stages or histologies outside those listed, or for other clinical settings.

The registry also lists progression-free survival, adverse effects, patient-reported quality of life, and patient-reported peripheral neuropathy symptoms as secondary outcomes. It does not provide values or comparative analyses for these outcomes in the posted results. Overall survival summaries alone do not describe those other outcomes. The record also does not report an analysis accounting for multiple outcomes or comparisons. No conclusion about treatment benefit, harm, or statistical significance can be drawn from the posted medians alone.

9. Statistical Methods Explained

The primary outcome is a time-to-event measure. Its starting point is study enrollment, and its event is death from any cause. Participants alive at last contact contribute follow-up up to that contact and are censored there. In general, censoring is necessary when the event time is not observed for every participant; it preserves the observed follow-up information without treating a censored participant as though their later event time were known. The registry does not report further details of the survival estimation procedure.

What does the median describe?

For a time-to-event outcome, the median is the estimated time by which half of the population under study has experienced the event. The reported medians are 60.0 months for paclitaxel poliglumex, 56.8 months for paclitaxel, and 58.3 months for observation. They describe the center of each estimated survival distribution. They do not show the full distribution of survival times, the number of participants surviving at a particular later time, or the experience of any individual participant.

In general, time-to-event medians can be estimated while retaining information from participants who have not experienced the event by the time their observation ends. This depends on handling censoring appropriately. The registry states that participants still alive at last follow-up were censored on their last contact date. It does not give details about the number or timing of censoring events, or the method used to estimate the medians.

How should the confidence intervals be read?

The registry reports 95% confidence intervals of 51.7 to 68.6 months for paclitaxel poliglumex, 47.3 to 65.9 months for paclitaxel, and 51.9 to 72.5 months for observation. In general, a confidence interval expresses statistical uncertainty about an estimated parameter under the assumptions and procedure used to construct it. It does not mean that 95% of participants had survival times inside the interval. The registry names the confidence level and interval bounds, but does not report the method used to calculate those intervals.

Confidence intervals for each group are not the same as a confidence interval for a between-group contrast. A direct comparison would require an estimate and inferential procedure for the difference or relative event rate between groups. No hazard ratio, contrast interval, test result, or p-value for overall survival is reported in the registry record. Although the group intervals overlap, that observation is not itself a test of the randomized comparison.

Why does censoring matter?

In general, survival analysis assumes that the censoring process is handled in a way that supports valid estimation. Censoring may occur because a participant is alive at the end of available follow-up or has no further recorded contact. If the reasons for censoring are related to the outcome in ways not addressed by the analysis, estimates may be difficult to interpret. The registry gives the rule for censoring participants alive at last follow-up but does not describe losses to follow-up, reasons for censoring, or analyses examining alternative assumptions.

Scheduled follow-up was described as physical exams and histories every three months for the first two years, every six months for the next three years, and annually for the next five years. A schedule describes planned observation intervals; it does not by itself establish that every participant completed every visit. Completeness and timing of follow-up are not reported in the registry record.

What do planning illustrations represent?

In general, a sample-size planning calculation asks how much information might be needed to detect a specified effect under stated assumptions. The planning illustrations associated with these results are described as based on the observed effect, with a two-sided significance level of 0.05, equal allocation between two arms, and a normal approximation. The effect to detect is a stated fraction of the observed effect. These are planning assumptions, not evidence that the trial was designed using those assumptions, and they are not observed power.

For time-to-event planning, the stated convention is to report the total number of events; the Schoenfeld method is named. For other outcomes, planning quantities are expressed as participants per arm. No planning values or protocol sample-size justification are reported in the registry record. The illustrations therefore should not be interpreted as a description of the trial's original design or as a post hoc claim about the probability that the trial detected an effect.

What is not available for an inferential comparison?

The posted primary results are medians and confidence intervals by group. The registry record does not report a hazard ratio, a log-rank test, an adjusted model, or another between-group analysis. The stated statistical meaning for the time-to-event outcome is that only sponsor-reported hazard ratios are used, but no such hazard ratio is included in these posted results. Consequently, the available numerical summaries support description of the group outcomes, not a reconstructed treatment-effect estimate.

10. Multiplicity, Missing Data and Analysis Populations

The registry identifies overall survival as the primary outcome and lists progression-free survival, frequency and severity of adverse effects, patient-reported quality of life, and patient-reported peripheral neuropathy symptoms as secondary outcomes. Four secondary outcomes are listed. The record does not report how multiplicity across outcomes, time points, or treatment comparisons was handled. It also does not report a prespecified hierarchy or adjustment procedure. Without that information, the role of any secondary findings in confirmatory inference cannot be determined.

The posted results include the overall-survival medians and confidence intervals, but no analyses are reported for the secondary outcomes. Missing outcome results should not be interpreted as showing no effect or no difference. The registry record does not report reasons for absent secondary results, the amount of missing patient-reported information, or the methods used to handle missing values.

For overall survival, the record says participants alive at last follow-up were censored on the date of last contact. It does not describe other missingness, loss to follow-up, censoring counts, or sensitivity analyses. The stated primary population is all randomized participants. The analysis populations used for the secondary outcomes and safety summaries are not described in detail.

The registry record does not report interim analyses, stopping rules, a statistical analysis plan, or a protocol-based sample-size justification. The planning illustrations are described as calculations based on the observed effect and stated assumptions; they should not be confused with the trial's original design rationale. These absences limit assessment of how outcomes, missing data, multiplicity, and analysis populations were addressed.

11. Safety Results

The registry reports serious adverse events as affected participants divided by participants at risk.

ArmParticipants with serious adverse eventsParticipants at riskPercentage
Arm I (Paclitaxel Poliglumex)5037913.2%
Arm II (Paclitaxel)3937410.4%
Arm III (Observation)13860.3%
Participants with at least one serious adverse event
Serious adverse events by armArm I (Paclitaxel Poliglumex)13.2%Arm II (Paclitaxel)10.4%Arm III (Observation)0.3%% of participants with at least one serious adverse event

Deaths

ArmDeaths (participants affected of at risk)
Arm I (Paclitaxel Poliglumex)235 of 387
Arm II (Paclitaxel)242 of 384
Arm III (Observation)230 of 386

Other (non-serious) adverse events

Participants with at least one non-serious event at or above the registry's 0% reporting threshold.

ArmParticipants affected of at risk
Arm I (Paclitaxel Poliglumex)378 of 379
Arm II (Paclitaxel)372 of 374
Arm III (Observation)312 of 386

Most frequent serious adverse event terms

Event termOrgan systemArm I (Paclitaxel Poliglumex)Arm II (Paclitaxel)Arm III (Observation)
Obstruction, Gi - Small Bowel NosGastrointestinal disorders4 of 3796 of 3740 of 386
Thrombosis/Thrombus/EmbolismVascular disorders4 of 3792 of 3740 of 386
NeutrophilsBlood and lymphatic system disorders2 of 3793 of 3740 of 386
Wound Complication, Non-InfectiousSkin and subcutaneous tissue disorders2 of 3791 of 3740 of 386
Obstruction, Gi - IleumGastrointestinal disorders0 of 3793 of 3740 of 386
IleusGastrointestinal disorders1 of 3792 of 3740 of 386
VomitingGastrointestinal disorders2 of 3791 of 3740 of 386
DehydrationGastrointestinal disorders2 of 3791 of 3740 of 386
Neuropathy-MotorNervous system disorders1 of 3792 of 3740 of 386
RhinitisImmune system disorders2 of 3790 of 3740 of 386

Most frequent non-serious adverse event terms

Event termOrgan systemArm I (Paclitaxel Poliglumex)Arm II (Paclitaxel)Arm III (Observation)
Neuropathy-SensoryNervous system disorders318 of 379294 of 374175 of 386
FatigueGeneral disorders254 of 379277 of 374143 of 386
HemoglobinBlood and lymphatic system disorders270 of 379283 of 37483 of 386
LeukocytesBlood and lymphatic system disorders229 of 379231 of 37444 of 386
Hair Loss/Alopecia (Scalp Or Body)Skin and subcutaneous tissue disorders135 of 379239 of 37476 of 386
NeutrophilsBlood and lymphatic system disorders190 of 379213 of 37428 of 386
ConstipationGastrointestinal disorders156 of 379158 of 37488 of 386
NauseaGastrointestinal disorders145 of 379137 of 37463 of 386
Pain: Abdominal Pain NosGeneral disorders111 of 379102 of 374120 of 386
Pain: JointGeneral disorders106 of 379133 of 37481 of 386

Serious events with the highest arm-level rate: obstruction, gi - small bowel nos (1.6%), thrombosis/thrombus/embolism (1.1%), neutrophils (0.8%), obstruction, gi - ileum (0.8%), ileus (0.5%).

Do not overextend the safety comparison. Serious-adverse-event counts are safety observations, not efficacy outcomes, and should not be combined with the primary result into a single benefit-risk number.

The registry reports serious adverse events among 379 participants at risk in the paclitaxel poliglumex group, 374 in the paclitaxel group, and 386 in the observation group. The corresponding counts affected by serious adverse events are 50, 39, and 1. These are group-level counts, not estimates of the causal effect of treatment. The registry does not provide a comparative statistical analysis of these figures.

For other adverse effects, the reported at-risk and affected counts are 379 and 378 for paclitaxel poliglumex, 374 and 372 for paclitaxel, and 386 and 312 for observation. The record labels these as other adverse effects, a category distinct from serious adverse events. The counts do not convey severity for each event or indicate how often an individual experienced repeated events.

The listed serious adverse-event terms include obstruction, GI - small bowel NOS at 1.6%, thrombosis/thrombus/embolism at 1.1%, neutrophils at 0.8%, obstruction, GI - ileum at 0.8%, ileus at 0.5%, and neuropathy-motor at 0.5%. The denominator and detailed coding basis for these percentages are not reported in the registry record. The listed terms should not be taken as a complete account of all serious events.

Deaths are listed as 235, 242, and 230 across the three groups. These counts are not accompanied by a safety comparison or attribution of cause in the posted results. Overall survival counts death from any cause, while adverse-event reporting has its own definitions and risk sets; the two types of figures should not be treated as interchangeable.

12. What the Result Does, and Does Not, Mean

The posted results describe median overall survival in three randomized groups after complete clinical response to primary platinum/taxane chemotherapy. The medians are 60.0 months for paclitaxel poliglumex, 56.8 months for paclitaxel, and 58.3 months for observation. Each is accompanied by a 95% confidence interval, conveying uncertainty in the group estimate. These summaries answer a descriptive question about the observed survival distributions in the registry's stated population.

They do not, on their own, establish that one strategy is superior, equivalent, or non-inferior to another. The registry does not report a hazard ratio or a formal between-group test for overall survival. No statistical significance conclusion can be recovered simply by comparing the medians or noting overlap between their confidence intervals. A valid inference about relative effects requires a defined comparison and its estimate and uncertainty, which are not reported in the posted results.

The trial's question is specific to maintenance strategies in participants who had achieved a complete clinical response to primary platinum/taxane chemotherapy. The results do not directly describe initial chemotherapy, people who did not achieve that response, or populations beyond the listed advanced ovarian, primary peritoneal, and fallopian tube cancers. They also do not answer questions about progression-free survival, quality of life, peripheral neuropathy symptoms, or the full comparative safety profile, because those results are not posted.

The safety figures give counts affected within reported risk sets and selected serious-event terms. They do not by themselves estimate comparative risk, account for differences in follow-up, or establish that an event was caused by a treatment. Likewise, deaths listed for each group should not be used to infer a survival comparison in place of the time-to-event analysis.

Overall, the registry supports a careful description of the group-specific survival estimates and selected safety counts. It does not supply the inferential detail needed to determine the statistical evidence for a difference between strategies. The absence of a posted comparison is not evidence that the strategies are the same; it is a limit on what can be concluded from this record.

13. Why This Trial Matters Statistically

This trial is statistically notable for asking a maintenance-treatment question against an observation group after response to primary chemotherapy. The randomized parallel design creates a framework for comparing treatment strategies in the enrolled population, while the no-masking design means the interventions were not masked. Overall survival is a time-to-event endpoint, so its interpretation depends on follow-up duration, censoring, and the way the survival distribution is estimated.

The registry provides group-specific medians and confidence intervals, which are useful descriptive summaries, but does not provide a hazard ratio, test, or other direct comparison for the primary outcome. This illustrates an important distinction: reporting an estimate for each group is not the same as reporting an estimate of the contrast between groups. The posted results can be read as estimates with uncertainty, but they do not give the inferential result needed to assess a treatment contrast.

The observation group also clarifies the clinical comparison: the study considered continued maintenance chemotherapy versus no further anticancer treatment until progression. This makes clear why the results should be interpreted in the post-response setting rather than generalized to all stages of treatment. The listed secondary outcomes indicate that the trial also considered progression, adverse effects, quality of life, and neuropathy symptoms, though their results are not included in the registry's posted analyses.

Finally, the record distinguishes observed results from planning illustrations based on the observed effect. That distinction matters because planning calculations are not observed power and do not substitute for a protocol's rationale or a reported treatment-effect analysis. Here, protocol-level sample-size justification, multiplicity handling, and inferential comparison details are not reported in the registry record. Those omissions define the boundary between what can be described and what can be concluded statistically.

14. Limitations

The main limitation of the posted results is that the primary outcome is reported by group without a direct inferential comparison. The registry includes medians and 95% confidence intervals but no hazard ratio, comparison interval, test statistic, or p-value for overall survival. As a result, the relative treatment effect and its statistical uncertainty cannot be assessed from these results alone.

The registry does not report the method used to estimate medians or confidence intervals, the detailed survival model, or checks of model assumptions. It states that participants alive at last follow-up were censored at last contact, but does not report censoring counts, reasons for incomplete follow-up, or sensitivity analyses. The follow-up schedule is described, but visit completion and completeness of outcome ascertainment are not reported.

Secondary outcomes are named but their numerical results and analyses are not posted. The multiplicity approach, analysis populations for secondary outcomes, handling of missing patient-reported data, interim analyses, and statistical analysis plan are not reported in the registry record. The overall study status is recorded as UNKNOWN, which also limits interpretation of the record's administrative status.

Safety results are presented as affected counts in reported risk sets, with selected serious-event terms and percentages. The record does not explain the denominator basis for those term percentages or provide a comparative safety model. The listed figures therefore do not establish treatment-attributable risk. Finally, sample-size illustrations are described as based on observed effects rather than as the trial's own design justification; the original sample-size rationale is not reported in the registry record.

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18. Record Summary

NCT00108745 is a randomized, open-label, parallel-group phase III trial sponsored by the GOG Foundation. It enrolled participants with advanced ovarian, primary peritoneal, or fallopian tube cancer who achieved a complete clinical response to primary platinum/taxane chemotherapy. The groups received paclitaxel poliglumex, paclitaxel, or observation.

Overall survival was defined as months from enrollment to death from any cause, with participants alive at last contact censored at that date. The registry reports medians of 60.0 months, 56.8 months, and 58.3 months, respectively, with group-specific 95% confidence intervals. A hazard ratio or formal primary-outcome comparison is not reported. Secondary outcomes are listed, but their analyses are not posted. The record lists a start date of 2005-03-21, a primary completion date of 2015-02-03, and status UNKNOWN.

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