1440 EMERGENCE OF VARIANT HISTOLOGY DURING NEO-ADJUVANT CHEMO-THERAPY FOR MUSCLE INVASIVE URETHELIAL BLADDER CANCER IS COMMON AND ASSOCIATED WITH POOR PROGNOSIS
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Résumé
You have accessJournal of UrologyBladder Cancer: Invasive (I)1 Apr 20131440 EMERGENCE OF VARIANT HISTOLOGY DURING NEO-ADJUVANT CHEMO-THERAPY FOR MUSCLE INVASIVE URETHELIAL BLADDER CANCER IS COMMON AND ASSOCIATED WITH POOR PROGNOSIS Rishikesh Pandya, David Margel, Laurel Patterson, Sebastien J. Hotte, Dean Daya, Bobby Shayegan, Som D. Mukherjee, and Jehonathan H Pinthus Rishikesh PandyaRishikesh Pandya Hamilton, Canada More articles by this author , David MargelDavid Margel Toronto, Canada More articles by this author , Laurel PattersonLaurel Patterson Hamilton, Canada More articles by this author , Sebastien J. HotteSebastien J. Hotte Hamilton, Canada More articles by this author , Dean DayaDean Daya Hamilton, Canada More articles by this author , Bobby ShayeganBobby Shayegan Hamilton, Canada More articles by this author , Som D. MukherjeeSom D. Mukherjee Hamilton, Canada More articles by this author , and Jehonathan H PinthusJehonathan H Pinthus Hamilton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2794AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cisplatin based neo-adjuvant chemotherapy (nCT) improves survival in patients with localized muscle invasive urethelial bladder cancer (MIUBC). Although the expected optimal effects of nCT on MIUBC are its down-staging or elimination pre-radical cystectomy (RC), it is not known whether nCT can also select for more aggressive variants of the disease. We attempted to address this question in this study. METHODS We analyzed our retrospective single tertiary center cohort of 84 unselected consecutive patients with MIUBC who were treated at our center. The diagnostic trans-urethral resection of bladder tumor (TURBT) and the final pathology obtained at RC (36 patients post-nCT and 48 upfront) were reviewed. The presence of any of the following histopathological elements was defined as variant histology (VH): neuro-endocrine carcinoma, micro-papillary carcinoma and sarcomatoid, squamous or glandular differentiation. Differences in survival were compared using the log rank test. RESULTS Median follow-up from time of RC was 18 months (range,1 to 153). VH was present on initial TUR in 20/84 patients (24%), but did not appear to be associated with adverse survival (log rank p=0.1). In contrast, if presence of VH was found in the RC specimen (17 patients, 20%) significantly worse overall survival was observed (HR 0.04, 95% CI 0.0094 - 0.17, p<0.0001). We then examined those patients who presented with urothelial carcinoma only on initial TUR but were found to have VH on RC: VH was seen in 7/24 patients (29%) during nCT compared to 4/39 patients (10%) who underwent upfront RC. Patients with VH after nCT had significantly worse survival compared to patients with no VH (HR 7.27, 95% CI 1.476-35.8; p=0.0147). Although down-staging occurred in 10 of the 36 patients (28%) who had nCT (including 5 (14%) with pathological complete response), down staging did not occur in any of the patients with VH following nCT. Moreover, 43% of the patients with VH after nCT had positive nodes at RC compared to 23% and 28% in patients with no VH during nCT or with upfront RC with no VH, respectively. CONCLUSIONS We report for the first time that VH can develop following cisplatin-based nCT for MIUBC. In our series this was common and associated with poorer survival. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e590 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishikesh Pandya Hamilton, Canada More articles by this author David Margel Toronto, Canada More articles by this author Laurel Patterson Hamilton, Canada More articles by this author Sebastien J. Hotte Hamilton, Canada More articles by this author Dean Daya Hamilton, Canada More articles by this author Bobby Shayegan Hamilton, Canada More articles by this author Som D. Mukherjee Hamilton, Canada More articles by this author Jehonathan H Pinthus Hamilton, 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 | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,056 | 0,016 |
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 ».