641 MANAGEMENT OF THE INTRAVESICAL URETER AND BLADDER CUFF DURING RADICAL NEPHROURETERECTOMY: OUTCOMES FROM THE CANADIAN UPPER TRACT COLLABORATION
Bibliographic record
Abstract
You have accessJournal of UrologyUrothelial Cancer: Upper Tract Tumors1 Apr 2012641 MANAGEMENT OF THE INTRAVESICAL URETER AND BLADDER CUFF DURING RADICAL NEPHROURETERECTOMY: OUTCOMES FROM THE CANADIAN UPPER TRACT COLLABORATION Anil Kapoor, Shawn Dason, Christopher Allard, Edward Matsumoto, Ricardo Rendon, David Bell, Jonathan Izawa, Joseph Chin, Alan So, Peter Black, Jean-Baptiste Lattouf, Fred Saad, Niels Jacobsen, Adrian Fairey, Darrel Drachenberg, Ilias Cagiannos, Yves Fradet, Louis Lacombe, Simon Tanguay, and Wassim Kassouf Anil KapoorAnil Kapoor Hamilton, Canada More articles by this author , Shawn DasonShawn Dason Hamilton, Canada More articles by this author , Christopher AllardChristopher Allard Hamilton, Canada More articles by this author , Edward MatsumotoEdward Matsumoto Hamilton, Canada More articles by this author , Ricardo RendonRicardo Rendon Halifax, Canada More articles by this author , David BellDavid Bell Halifax, Canada More articles by this author , Jonathan IzawaJonathan Izawa London, Canada More articles by this author , Joseph ChinJoseph Chin London, Canada More articles by this author , Alan SoAlan So Vancouver, Canada More articles by this author , Peter BlackPeter Black Vancouver, Canada More articles by this author , Jean-Baptiste LattoufJean-Baptiste Lattouf Montreal, Canada More articles by this author , Fred SaadFred Saad Montreal, Canada More articles by this author , Niels JacobsenNiels Jacobsen Edmonton, Canada More articles by this author , Adrian FaireyAdrian Fairey Edmonton, Canada More articles by this author , Darrel DrachenbergDarrel Drachenberg Winnipeg, Canada More articles by this author , Ilias CagiannosIlias Cagiannos Ottawa, Canada More articles by this author , Yves FradetYves Fradet Quebec City, Canada More articles by this author , Louis LacombeLouis Lacombe Quebec City, Canada More articles by this author , Simon TanguaySimon Tanguay Montreal, Canada More articles by this author , and Wassim KassoufWassim Kassouf Montreal, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.720AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A number of surgical approaches exist for management of the intravesical ureter and bladder cuff during radical nephrouretectomy (RNU) for upper tract urothelial carcinoma (UTUC). This study examines how surgical approach during RNU impacts clinical outcomes based on an analysis of a multicenter Canadian UTUC database. METHODS Detailed information on 1029 UTUC patients treated with RNU between 1994 and 2009 was obtained from 10 Canadian academic centers. Available data included bladder cuff management as well as recurrence and survival status. Surgical approach was divided into extravesical management (TENT) (bladder never opened, ureter taken as distal as possible with tenting of the bladder), open bladder cuff excision (OPEN) (bladder opened for complete removal of intramural ureter), and endoscopic management (ENDO) (ureter taken as distal as possible during RNU with endoscopic management concomitantly or staged). The clinical outcomes were overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS). Survival analysis was performed with the Kaplan-Meier method and the log-rank test. Cox proportional regression analysis was used for multivariate analysis. RESULTS 820 of 1029 (79.7%) patients had sufficient data for inclusion. 316 (38.5%) patients underwent TENT, 406 (49.5%) underwent OPEN, and 97 (11.8%) underwent ENDO. Median follow-up was 24.6 months (Q1=8.2 months, Q3=56.9 months). Groups differed significantly in the proportion of females, previous UTUC, laparoscopic cases, presence of carcinoma in situ and pathological tumor stage (p<0.05). In univariate and multivariate analyses, no significant differences were found in OS or DSS based on surgical approach. In multivariate analysis, OPEN was found to reduce tumor recurrence compared to TENT (hazard ratio 0.628, 95% CI 0.491-0.801, p=0.0002). ENDO did not improve RFS relative to TENT (p=0.644). CONCLUSIONS In a multicenter Canadian series of 820 patients undergoing radical nephroureterectomy for UTUC with a median follow-up of over 2 years, management of the bladder cuff did not affect overall or disease-specific survival. An open intravesical bladder cuff excision was associated with improved recurrence-free survival. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187 Issue 4S April 2012 Page: e261 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Metrics Author Information Anil Kapoor Hamilton, Canada More articles by this author Shawn Dason Hamilton, Canada More articles by this author Christopher Allard Hamilton, Canada More articles by this author Edward Matsumoto Hamilton, Canada More articles by this author Ricardo Rendon Halifax, Canada More articles by this author David Bell Halifax, Canada More articles by this author Jonathan Izawa London, Canada More articles by this author Joseph Chin London, Canada More articles by this author Alan So Vancouver, Canada More articles by this author Peter Black Vancouver, Canada More articles by this author Jean-Baptiste Lattouf Montreal, Canada More articles by this author Fred Saad Montreal, Canada More articles by this author Niels Jacobsen Edmonton, Canada More articles by this author Adrian Fairey Edmonton, Canada More articles by this author Darrel Drachenberg Winnipeg, Canada More articles by this author Ilias Cagiannos Ottawa, Canada More articles by this author Yves Fradet Quebec City, Canada More articles by this author Louis Lacombe Quebec City, Canada More articles by this author Simon Tanguay Montreal, Canada More articles by this author Wassim Kassouf Montreal, Canada 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 | 0.002 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.005 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".