Impact of treatment delay in patients with bladder cancer managed with partial cystectomy in Quebec: a population-based study
Bibliographic record
Abstract
Objective: Treatment delays have been associated with adverseoutcomes in patients with bladder cancer treated with radical cystectomy(RC). We sought to evaluate the impact of treatment delayon disease recurrence and survival in patients with bladder cancertreated with partial cystectomy (PC) in Quebec.Methods: We reviewed and obtained billing records for allpatients who underwent PC and/or RC for bladder cancer inQuebec between 1983 and 2005. Analysis included age, sex,year of surgery, surgeon’s age, hospital type, preoperative andpostoperative visits with accompanying diagnoses and datesof death.Results: A total of 714 patients underwent PC. The median patientage was 70 years. Two-hundred nineteen (30.7%) patients experiencedrecurrence; of these, 52 (23.7%) required salvage RC.Five-year overall and recurrence-free survival for patients whounderwent PC were 49.8% and 40.3%, respectively. Patientsdelayed more than 12 weeks from transurethral resection of bladdertumours (TURBT) to PC were at significantly increased riskof requiring salvage RC compared with those delayed 12 weeksor less (hazard ratio [HR] 3.0, p < 0.001). Patients who underwentsalvage RC had worse survival than patients who had upfrontRC (HR 1.5, p = 0.006). Variables including age, sex, presenceof hematuria, intravesical therapy, surgeon age, hospital PC volume,surgeon PC volume, type of hospital (academic v. nonacademic)or year of surgery were not significantly associated withPC treatment delay.Conclusion: Treatment delay in patients with bladder cancer managedwith PC was associated with increased risk of salvage RC.Patients with bladder cancer who underwent salvage RC had worseoutcomes than those who had upfront cystectomy.Objectif : Chez les patients atteints de cancer de la vessie traitéspar cystectomie radicale (CR), un délai avant l’instauration dutraitement est associé à des résultats défavorables. Nous avonstenté d’évaluer l’impact d’un tel délai sur la récidive de la maladieet le taux de survie des patients atteints de cancer de la vessietraités par cystectomie partielle (CP) au Québec.Méthodologie : Les dossiers de facturation ont été obtenus pourles patients ayant subi une CP et/ou une CR pour le traitement d’uncancer de la vessie au Québec de 1983 à 2005. L’analyse tenaitcompte de l’âge, du sexe, de l’année de l’intervention chirurgicale,de l’âge du chirurgien, du type d’hôpital, des visites préopératoireset postopératoires, des comorbidités et des dates de décès.Résultats : En tout, 714 patients dont l’âge moyen était de 70 ansont subi une CP. De ce nombre, 219 patients (30,7 %) ont présentéune récidive, dont 52 (23,7 %) nécessitant une CR de sauvetage.La survie globale après 5 ans et la survie sans récidive chezles patients ayant subi une CP étaient respectivement de 49,8 %et de 40,3 %. Un intervalle supérieur à 12 semaines entre la résectiontransurétrale de la tumeur et la CP a été associé à un tauxaccru de CR de sauvetage en comparaison avec un intervallede 12 semaines ou moins (risque relatif [RR] 3,0, p < 0,001]. LaCR de sauvetage était associée à un taux inférieur de survie encomparaison avec les patients traités par CR dès le départ (RR 1,5,p = 0,006). Les autres variables, soit l’âge, le sexe, la présenced’une hématurie, le recours à une thérapie intravésicale, l’âgedu chirurgien, le nombre de CP effectuées à l’hôpital, le nombrede CP effectuées par le chirurgien, le type d’hôpital (universitaireou non universitaire), et l’année de l’intervention chirurgicalen’ont pas été associées de façon significative au délaiavant la CP.Conclusion : Le délai avant l’instauration du traitement chez lespatients atteints de cancer de la vessie traités par CP a été associéà un taux accru de CR de sauvetage. Les patients atteints decancer de la vessie qui ont subi une CR de sauvetage présentaientune issue de la maladie moins favorable que les patients traitéspar cystectomie dès le départ.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".