1440 EMERGENCE OF VARIANT HISTOLOGY DURING NEO-ADJUVANT CHEMO-THERAPY FOR MUSCLE INVASIVE URETHELIAL BLADDER CANCER IS COMMON AND ASSOCIATED WITH POOR PROGNOSIS
Bibliographic record
Abstract
You have accessJournal of UrologyBladder Cancer: Invasive (I)1 Apr 20131440 EMERGENCE OF VARIANT HISTOLOGY DURING NEO-ADJUVANT CHEMO-THERAPY FOR MUSCLE INVASIVE URETHELIAL BLADDER CANCER IS COMMON AND ASSOCIATED WITH POOR PROGNOSIS Rishikesh Pandya, David Margel, Laurel Patterson, Sebastien J. Hotte, Dean Daya, Bobby Shayegan, Som D. Mukherjee, and Jehonathan H Pinthus Rishikesh PandyaRishikesh Pandya Hamilton, Canada More articles by this author , David MargelDavid Margel Toronto, Canada More articles by this author , Laurel PattersonLaurel Patterson Hamilton, Canada More articles by this author , Sebastien J. HotteSebastien J. Hotte Hamilton, Canada More articles by this author , Dean DayaDean Daya Hamilton, Canada More articles by this author , Bobby ShayeganBobby Shayegan Hamilton, Canada More articles by this author , Som D. MukherjeeSom D. Mukherjee Hamilton, Canada More articles by this author , and Jehonathan H PinthusJehonathan H Pinthus Hamilton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2794AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cisplatin based neo-adjuvant chemotherapy (nCT) improves survival in patients with localized muscle invasive urethelial bladder cancer (MIUBC). Although the expected optimal effects of nCT on MIUBC are its down-staging or elimination pre-radical cystectomy (RC), it is not known whether nCT can also select for more aggressive variants of the disease. We attempted to address this question in this study. METHODS We analyzed our retrospective single tertiary center cohort of 84 unselected consecutive patients with MIUBC who were treated at our center. The diagnostic trans-urethral resection of bladder tumor (TURBT) and the final pathology obtained at RC (36 patients post-nCT and 48 upfront) were reviewed. The presence of any of the following histopathological elements was defined as variant histology (VH): neuro-endocrine carcinoma, micro-papillary carcinoma and sarcomatoid, squamous or glandular differentiation. Differences in survival were compared using the log rank test. RESULTS Median follow-up from time of RC was 18 months (range,1 to 153). VH was present on initial TUR in 20/84 patients (24%), but did not appear to be associated with adverse survival (log rank p=0.1). In contrast, if presence of VH was found in the RC specimen (17 patients, 20%) significantly worse overall survival was observed (HR 0.04, 95% CI 0.0094 - 0.17, p<0.0001). We then examined those patients who presented with urothelial carcinoma only on initial TUR but were found to have VH on RC: VH was seen in 7/24 patients (29%) during nCT compared to 4/39 patients (10%) who underwent upfront RC. Patients with VH after nCT had significantly worse survival compared to patients with no VH (HR 7.27, 95% CI 1.476-35.8; p=0.0147). Although down-staging occurred in 10 of the 36 patients (28%) who had nCT (including 5 (14%) with pathological complete response), down staging did not occur in any of the patients with VH following nCT. Moreover, 43% of the patients with VH after nCT had positive nodes at RC compared to 23% and 28% in patients with no VH during nCT or with upfront RC with no VH, respectively. CONCLUSIONS We report for the first time that VH can develop following cisplatin-based nCT for MIUBC. In our series this was common and associated with poorer survival. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e590 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rishikesh Pandya Hamilton, Canada More articles by this author David Margel Toronto, Canada More articles by this author Laurel Patterson Hamilton, Canada More articles by this author Sebastien J. Hotte Hamilton, Canada More articles by this author Dean Daya Hamilton, Canada More articles by this author Bobby Shayegan Hamilton, Canada More articles by this author Som D. Mukherjee Hamilton, Canada More articles by this author Jehonathan H Pinthus Hamilton, 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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.056 | 0.016 |
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".