Patient-specific rubric-based evaluation of large language models across longitudinal cancer care

The study introduces NPC‑RubricBench, a phase‑aware benchmark that evaluates large language models (LLMs) on multistage clinical reasoning throughout the nasopharyngeal carcinoma care continuum. Using longitudinal data from 405 patients, the benchmark contains 941 patient‑phase units and 17,688 patient‑specific criteria across five dimensions, focusing strictly on decision‑time evidence. Evaluation of 30 general‑purpose and medical LLMs shows that strong diagnostic accuracy does not translate into better downstream care, with failure modes shifting from explicit decision errors in staging to decision omissions in initial work‑up and follow‑up, and reveals a trade‑off between prompt granularity, decision quality, evidence faithfulness, and safety adherence.

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• llms
• benchmarks
• safety