1869 UTILIZATION AND IMPACT OF PERI-OPERATIVE CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER: A POPULATION-BASED OUTCOMES STUDY
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Résumé
You have accessJournal of UrologyBladder Cancer: Metastatic Disease + Staging1 Apr 20131869 UTILIZATION AND IMPACT OF PERI-OPERATIVE CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER: A POPULATION-BASED OUTCOMES STUDY D. Siemens, Gavin Li, Paul Peng, Ian Tannock, Ahmed Elharram, Weidong Kong, William Mackillop, and Chris Booth D. SiemensD. Siemens Kingston, Canada More articles by this author , Gavin LiGavin Li Kingston, Canada More articles by this author , Paul PengPaul Peng Kingston, Canada More articles by this author , Ian TannockIan Tannock Tornoto, Canada More articles by this author , Ahmed ElharramAhmed Elharram Kingston, Canada More articles by this author , Weidong KongWeidong Kong Kingston, Canada More articles by this author , William MackillopWilliam Mackillop Kingston, Canada More articles by this author , and Chris BoothChris Booth Kingston, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2288AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The utilization of perioperative chemotherapy for bladder cancer in the general population and the survival benefit associated with therapy is not well described. Here we report practice patterns and outcomes associated with peri-operative chemotherapy in the general population of Ontario, Canada. METHODS Electronic records of treatment were linked to the population-based Ontario Cancer Registry to identify all patients who underwent cystectomy for bladder cancer in Ontario 1994-2008; surgical pathology reports were obtained to identify cases with muscle-invasive disease. Utilization of neoadjuvant (NACT) and adjuvant (ACT) chemotherapy was compared across 3 study periods: 1994-98, 1999-03, 2004-08. Logistic regression was used to analyze factors associated with use of NACT/ACT. A Cox model and propensity score analysis was used to explore the association between ACT and survival. RESULTS In 1994-2008 4876 patients underwent cystectomy; surgical pathology reports were identified for 3429 cases of which 2738 had muscle-invasive disease. While use of NACT did not change substantially over the 3 study periods (5%, 3%, 6%; p=0.004), utilization of ACT increased with time (16%, 19%, 23%; p=0.001). In adjusted analyses younger age and less co-morbidity were associated with greater utilization of NACT and ACT. T3/T4 tumors (OR 2.1, 95%CI 1.6-2.8), node positive disease (OR 7.2, 95%CI 5.5-9.5), and presence of lymphovascular invasion (OR 1.7, 95%CI 1.2-2.3) were associated with greater utilization of ACT. While there was no substantial variation in utilization of NACT across geographic regions (range 3% to 5%), regional use of ACT varied considerably (range 12% to 31%). Five year overall (OS) and cancer-specific survival (CSS) for all muscle-invasive cases were 30% (95%CI 28-31%) and 34% (95%CI 32-36%) respectively. In Cox analysis T3/T4 tumors (HR 1.7, 95%CI 1.6-2.0), node positive disease (HR 1.9, 95%CI 1.7-2.1), and lymphovascular invasion (HR 1.8, 95%CI 1.6-2.1) were independently associated with inferior OS. Utilization of ACT was associated with improved OS (HR 0.70, 95%CI 0.6-0.8) and improved CSS (HR 0.70, 95%CI 0.6-0.8). CONCLUSIONS Despite accumulating evidence and guidelines, NACT/ACT remains substantially underutilized in routine clinical practice. Our results suggest that ACT is associated with a substantial survival benefit in the general population. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e766 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information D. Siemens Kingston, Canada More articles by this author Gavin Li Kingston, Canada More articles by this author Paul Peng Kingston, Canada More articles by this author Ian Tannock Tornoto, Canada More articles by this author Ahmed Elharram Kingston, Canada More articles by this author Weidong Kong Kingston, Canada More articles by this author William Mackillop Kingston, Canada More articles by this author Chris Booth Kingston, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,004 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».