PD38-10 STENTING VERSUS NEPHROSTOMY TUBES FOR BLADDER CANCER ASSOCIATED WITH HYDRONEPHROSIS: DOES STENTING INCREASE THE INCIDENCE OF UPPER TRACT UROTHELIAL CARCINOMA BY RETROGRADE TUMOR CELL SEEDING?
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Résumé
You have accessJournal of UrologyBladder Cancer: Invasive IV (PD38)1 May 2024PD38-10 STENTING VERSUS NEPHROSTOMY TUBES FOR BLADDER CANCER ASSOCIATED WITH HYDRONEPHROSIS: DOES STENTING INCREASE THE INCIDENCE OF UPPER TRACT UROTHELIAL CARCINOMA BY RETROGRADE TUMOR CELL SEEDING? Marian S. Wettstein, Rui M. Bernardino, Harkanwal Randhawa, Jethro C. C. Kwong, Douglas C. Cheung, Khatereh Aminoltejari, Neil E. Fleshner, Alexandre R. Zlotta, and Girish S. Kulkarni Marian S. WettsteinMarian S. Wettstein , Rui M. BernardinoRui M. Bernardino , Harkanwal RandhawaHarkanwal Randhawa , Jethro C. C. KwongJethro C. C. Kwong , Douglas C. CheungDouglas C. Cheung , Khatereh AminoltejariKhatereh Aminoltejari , Neil E. FleshnerNeil E. Fleshner , Alexandre R. ZlottaAlexandre R. Zlotta , and Girish S. KulkarniGirish S. Kulkarni View All Author Informationhttps://doi.org/10.1097/01.JU.0001009424.64728.0c.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hydronephrosis in the setting of bladder cancer is not uncommon. It can be either caused by tumor-related compression of the ureter/ureteric orifice or by transurethral resection-associated periorificial tissue swelling/edema. It is possible that decompression of the hydronephrosis by stenting instead of nephrostomy tube insertion is associated with an increased incidence of upper tract urothelial carcinoma (UTUC) due to potential retrograde tumor cell seeding. However, prior evidence is conflicting. Hence, the aim of our study was to investigate the association between type of decompression and UTUC incidence during follow-up. METHODS: We designed an observational study based on bladder cancer pathology reports linked to health administrative databases within the province of Ontario, Canada. Patients who underwent transurethral resection/biopsy of a urothelial bladder cancer between January 2001 and December 2015 that received upper tract decompression by stenting or nephrostomy insertion within 7 days were included. We excluded patients who were diagnosed with UTUC between 3 years of the index date up to 7 days after the index date and followed the cohort for the occurrence of UTUCs by querying the Ontario Cancer Registry. The association between type of decompression (reference: nephrostomy tube) and time to UTUC was quantified by unadjusted and adjusted Cox proportional hazards regression analysis. Patients were censored at the date of death or at the date of the last contact with the health care system. Effected estimates are presented as hazard ratios (HR [95% confidence intervals]). RESULTS: We identified 973 patients diagnosed with bladder cancer but not with prior UTUC who underwent decompression by either stenting (48.3%, N=470) or nephrostomy tube insertion (51.7%; N=503). During a median follow-up time of 10.9 years (interquartile range: 8.7 to 14.1 years), a UTUC occurred in 55 (5.7%) patients at a median time of 20.0 months (3.4 to 56.4 months). During any time to follow-up stenting compared to nephrostomy insertion was associated with a higher incidence of UTUCs in unadjusted analysis (HR 2.30 [1.31 to 4.05). The association remained statistically significant (HR 1.85 [1.02 to 3.36]) even after adjusting for assumed confounding variables (cT stage and grade). CONCLUSIONS: Our data supports the hypothesis of retrograde tumor cell seeding in urothelial carcinomas. Although the incidence of upper tract urothelial carcinoma is low, decompression of the upper urinary tract in patients harboring bladder cancer should ideally be achieved by nephrostomy tube insertion. This study is limited by missing information on laterality of decompression and UTUC incidence. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e810 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Marian S. Wettstein More articles by this author Rui M. Bernardino More articles by this author Harkanwal Randhawa More articles by this author Jethro C. C. Kwong More articles by this author Douglas C. Cheung More articles by this author Khatereh Aminoltejari More articles by this author Neil E. Fleshner More articles by this author Alexandre R. Zlotta More articles by this author Girish S. Kulkarni More articles by this author Expand All 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 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,002 |
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 ».