MP77-13 DOWNSTAGING OF PRIMARY VS. SECONDARY MUSCLE INVASIVE BLADDER CANCER AFTER CYSTECTOMY AND ITS ASSOCIATION WITH SURVIVAL
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Résumé
You have accessJournal of UrologyBladder Cancer: Invasive VI (MP77)1 May 2024MP77-13 DOWNSTAGING OF PRIMARY VS. SECONDARY MUSCLE INVASIVE BLADDER CANCER AFTER CYSTECTOMY AND ITS ASSOCIATION WITH SURVIVAL Jessica E. Caterini, Wassim Kassouf, Rodney H. Breau, Adrian Fairey, Ramana-Kumar Agnihotram, Nimira Alimohamed, Jasmir G. Nayak, Jean-Baptiste Lattouf, Michele Lodde, Ricardo Rendon, Peter Black, Girish S. Kulkarni, Peter Chung, and D. Robert Siemens Jessica E. CateriniJessica E. Caterini , Wassim KassoufWassim Kassouf , Rodney H. BreauRodney H. Breau , Adrian FaireyAdrian Fairey , Ramana-Kumar AgnihotramRamana-Kumar Agnihotram , Nimira AlimohamedNimira Alimohamed , Jasmir G. NayakJasmir G. Nayak , Jean-Baptiste LattoufJean-Baptiste Lattouf , Michele LoddeMichele Lodde , Ricardo RendonRicardo Rendon , Peter BlackPeter Black , Girish S. KulkarniGirish S. Kulkarni , Peter ChungPeter Chung , and D. Robert SiemensD. Robert Siemens View All Author Informationhttps://doi.org/10.1097/01.JU.0001009404.49693.12.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although previous studies have suggested that patients who progress to muscle-invasive bladder cancer (secondary MIBC) after previous treatment for non-invasive disease have worse outcomes than those that present de novo (primary MIBC), recent studies have been conflicting. Further, there is emerging evidence that secondary MIBC may be more resistant to peri-operative chemotherapy. This study aimed to assess differences in downstaging and association with survival outcomes in patients with primary MIBC compared to secondary MIBC in a retrospective cohort from tertiary care centres. METHODS: This retrospective multicentre study utilized the Canadian Bladder Cancer Information System (CBCIS) database, which includes patient, tumor, and treatment data from 14 centres in Canada. The main outcome from downstaging at cystectomy defined as <pT2. Cox's proportional hazards models and multivariable regression, adjusted for key patient and treatment variables, assessed factors associated with downstaging and overall survival (OS). RESULTS: During the study period 908 patients received cystectomy between January 2017 and September 2020. Patients had localized primary MIBC (n=678) or secondary MIBC (n=230). There were no differences in baseline variables based on MIBC status including sex, clinical stage, variant pathology or use of neoadjuvant chemotherapy (NAC, 47% vs. 44%, p=0.43). Post-operatively, there were differences in lymph node metastases (primary vs. secondary; 16% vs. 59%, p=0.037) and use of NAC (5 vs. 9%, p=0.016). Downstaging to <pT2 for primary MIBC was 28% vs. 14% with secondary MIBC (p<0.001) and downstaging to pT0 was 15% vs. 5%. Multivariable analysis associated with downstaging at cystectomy included urothelial (vs. variant) pathology (Odds Ratio (OR) 6.39 95% Confidence Interval (CI), 3.22-12.69), use of NAC (OR 2.23, 95% CI 1.39-3.60) and primary vs. secondary MIBC (OR 2.65, 95% CI 1.50-4.71). Lower OS was also associated with secondary vs. primary MIBC (HR, 2.90, 95% CI 1.64-5.14, p<0.0001). CONCLUSIONS: Patients with MIBC with secondary, progressed disease had decreased survival on multivariable analysis. Further, this was associated with lower downstaging rates post-cystectomy versus those with de novo, primary MIBC. While these observations are likely confounded by assessed clinical stage at the time of cystectomy, they support further work investigating the chemosensitivity of MIBC that has progressed from non-invasive disease as it may represent a more global, treatment-resistant phenotype. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1257 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jessica E. Caterini More articles by this author Wassim Kassouf More articles by this author Rodney H. Breau More articles by this author Adrian Fairey More articles by this author Ramana-Kumar Agnihotram More articles by this author Nimira Alimohamed More articles by this author Jasmir G. Nayak More articles by this author Jean-Baptiste Lattouf More articles by this author Michele Lodde More articles by this author Ricardo Rendon More articles by this author Peter Black More articles by this author Girish S. Kulkarni More articles by this author Peter Chung More articles by this author D. Robert Siemens 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 | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
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 ».