Correlation of the clinical frailty scale with long-term survival after radical cystectomy.
Bibliographic record
Abstract
314 Background: Demographic changes account for an increasingly large proportion of elderly patients with urothelial carcinoma of the bladder. It remains under debate to which extent a patient might benefit from major surgery such as the radical cystectomy. Current tools for preoperative assessment of biological age might be of limited significance. The frailty concept, which refers to a biological syndrome of decreased reserve to stressors and resistance to stressors, has gained recent recognition for measuring patient’s physiological reserve and has been linked to adverse outcomes after surgery. Methods: Clinical, surgical and pathological data of patients undergoing radical cystectomy and lymph node dissection at Hannover Medical School with a minimum age of 60 years were retrospectively collected from 2000 to 2010. Frailty was assessed using the clinical frailty scale by Rockwood et al. derived from the Canadian Study of Health and Aging (CSHA). The relationship between frailty and various risk assessment tools such as the ASA-score, Charlson Comorbidity Index (CCI) and Karnofsky score (KS) in regard of long-term follow-up data was analyzed. Results: Our cohort included 255 patients (male 197, female 58). Mean age was 70 years (SD ±6.14). Patients were categorized into “not frail” (n=53, 21%), “vulnerable and mildly frail” (n=156, 61%), and “moderately/severely frail” (n=46, 18%). Higher CSHA was associated with increased CCI and higher rate of perioperative complications (each p<0.001). 179 (70%) patients had died during follow-up (mean follow-up, 61 months). Median survival differed significantly between groups (68 vs. 29 vs. 12 months, p<0.0001). In univariate analyses ASA, CCI, KI, and CSHA correlated with long-term survival (each p<0.001). In multivariate analysis only CSHA remained predictor of survival besides age, lymph node involvement, resection margins, and T-stage. Conclusions: The clinical frailty scale is an easy to use tool. It correlates with survival and perioperative complications after radical cystectomy. This study warrants further assessment of the frailty concept; however, it still has to be determined whether the clinical frailty scale is superior to other frailty assessment schemes.
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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 | 0.005 |
| 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 | 0.000 | 0.000 |
| Open science | 0.000 | 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".