Radical cystectomy for patients with pT4 urothelial carcinoma in a large population‐based study
Bibliographic record
Abstract
Study Type – Therapy (cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Given the natural history of pT4 urothelial carcinoma of the urinary bladder, and the substantially poorer survival of pT4 patients relative to pT3, it may be argued that radical cystectomy is not justified in these patients. Relying on a large population‐based retrospective analysis, the current study identified two main categories of patients with pT4 urothelial carcinoma of the urinary bladder. The first comprised of patients with pT4b disease, whose disease phenotype was clearly more aggressive than their pT3 counterparts. The second group consisted of patients with pT4a disease, whose disease phenotype was very similar to patients with pT3. These findings indicate that patients with pT4b disease should be provided with the maximal amount of therapeutic interventions, such as administration of early adjuvant chemotherapy and perhaps early adjuvant radiotherapy. OBJECTIVE To examine cancer‐specific mortality (CSM) in patients with pT4N 0–3 M 0 urothelial carcinoma of the urinary bladder (UCUB) and to compare it to patients with pT3N 0–3 M 0 , in a population‐based cohort treated with radical cystectomy (RC). PATIENTS AND METHODS RCs were performed in 5625 pT3‐T4bN 0–3 M 0 patients with UCUB within 17 Surveillance, Epidemiology and End Results (SEER) registries between 1988 and 2006. Univariable and multivariable models tested the effect of pT4a vs pT4b vs pT3 stages on CSM. Covariates consisted of age, gender, race, lymph node status and SEER registries. All analyses were repeated in 3635 pN 0 patients. RESULTS Of 5625 patients, 2043 (36.3%) had pT4aN 0–3 , 248 (4.4%) had pT4bN 0–3 and 3334 had pT3N 0–3 (59.3%) UCUB. The 5‐year CSM was 57.6% vs 81.7% vs 53.9% for, respectively, pT4aN 0–3 vs pT4bN 0–3 vs pT3N 0–3 patients (all log‐rank P = 0.008). In multivariable analyses the rate of CSM was 2.3‐fold higher in pT4b vs pT3 ( P < 0.001), 1.1‐fold higher in pT4a vs pT3 ( P = 0.002) and 2.0‐fold higher in pT4a vs pT4b patients. After restriction to pN 0 stage, pT4b patients had a 2.3‐fold higher rate of CSM than pT3 patients ( P < 0.001) and pT4b patients had a 2.1‐fold higher rate of CSM than pT4a patients ( P < 0.001). The CSM rate was the same for pT4a and pT3 patients ( P = 0.1). CONCLUSIONS Our findings indicate that patients with pT4a UCUB have similar CSM as those with pT3 UCUB. Consequently, RC should be given equal consideration in patients with pT3 and pT4a UCUB.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".