486 LYMPH NODE DENSITY: UTILITY IN STRATIFYING PATIENTS FOR ADJUVANT THERAPY AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER
Bibliographic record
Abstract
You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2011486 LYMPH NODE DENSITY: UTILITY IN STRATIFYING PATIENTS FOR ADJUVANT THERAPY AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER Eugene Lee, Harry Herr, Wassim Kassouf, Mark Munsell, H. Barton Grossman, Colin Dinney, and Ashish Kamat Eugene LeeEugene Lee Houston, TX More articles by this author , Harry HerrHarry Herr New York, NY More articles by this author , Wassim KassoufWassim Kassouf Montreal, Canada More articles by this author , Mark MunsellMark Munsell Houston, TX More articles by this author , H. Barton GrossmanH. Barton Grossman Houston, TX More articles by this author , Colin DinneyColin Dinney Houston, TX More articles by this author , and Ashish KamatAshish Kamat Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.581AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with nodal metastasis detected at radical cystectomy for bladder cancer have an overall poor prognosis and are often considered for adjuvant chemotherapy. We explore the utility of lymph node density (LND) for stratifying these patients based on disease specific survival (DSS). METHODS From a pooled database from M. D. Anderson Cancer Center (MDACC) and Memorial Sloan-Kettering Cancer Center (MSKCC), we identified 248 patients with nodal metastasis after radical cystectomy (performed from 1979–2003). Of these patients, 143 had at least 8 nodes evaluable (surrogate marker for “adequate” nodal dissection) and did not receive neoadjuvant or adjuvant chemotherapy. The Kaplan-Meier product-limit estimator and Cox proportional hazards regression model were used to assess DSS at different LND cutoffs. RESULTS The mean and median follow-up for the patients was 45.9 months and 30.0 months, respectively (range 0.5 to 122). For those patients alive at last follow-up, the median follow-up was 66.0 months. There were 81 patients who died of their disease with an overall median DSS of 39.5 months. The 2-year DSS was 62.0% (95% CI 53.2%–69.6%), and the 5-year DSS was 38.1% (95% CI 29.4% to 46.6%). DSS was intimately linked to LND at the 10%, 15%, 20%, 25%, 30%, and 35% cut points (p<0.001). Patients with LND < 15% (n=66 with 23 deaths from disease) had a 5 year DSS of 61.1%. Conversely, patients with a LND > 15% (n=77 with 58 deaths from disease) had a 5 yr DSS of 19.2%. Survival worsened as LND increased, such that only 4% of patients with LND > 35% (n=26 with 24 deaths from disease) were alive at 5 years. CONCLUSIONS In the context of an adequate node dissection, LND may be used as a tool to risk-stratify patients and select appropriate candidates for adjuvant chemotherapy. Furthermore, this concept would be useful when reporting the results of ongoing trials of adjuvant chemotherapy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e198 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eugene Lee Houston, TX More articles by this author Harry Herr New York, NY More articles by this author Wassim Kassouf Montreal, Canada More articles by this author Mark Munsell Houston, TX More articles by this author H. Barton Grossman Houston, TX More articles by this author Colin Dinney Houston, TX More articles by this author Ashish Kamat Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".