Canadian Urological Association/Genitourinary Medical Oncologists of Canada consensus statement: Management of unresectable locally advanced and metastatic urothelial carcinoma
Bibliographic record
Abstract
Warren et al Unresectable locally advanced and metastatic urothelial carcinoma advances in systemic therapy, especially due to the emergence of immunotherapy as a therapeutic option, a consensus opinion has become necessary to guide the management of unresectable locally advanced and metastatic urothelial carcinoma. MethodsA literature review was undertaken evaluating studies of unresectable locally advanced and metastatic urothelial carcinoma with a greater emphasis on prospective randomized studies.A search of Medline, Embase and Pubmed in addition to other published guidelines was used to identify relevant studies.A summary of the evidence was created with draft recommendations pertaining to various aspects of the management of advanced urothelial carcinoma.This was distributed to members of GUMOC for review and discussion through which a consensus opinion was established.The following statements focus predominantly on systemic management which falls in the realm of the Medical Oncology specialty.Additionally, the management of advanced, unresectable urothelial cancer is multidisciplinary in nature as there are times when surgery and / or radiotherapy have a role to play, particularly in patients with oligometastatic disease and those with locally advanced disease.In this consensus statement, we define locally advanced disease as cT4b and / or cN1-3.Statements pertaining to these aspects of management are intended to provide guidance for treating clinicians as to when to consider referral for multidisciplinary discussion.They are not intended to mandate a particular management plan that arises from such a forum.All recommended systemic treatment regimens are outlined in Table 1.Systemic therapy for unresectable locally advanced and metastatic urothelial carcinoma
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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 | 0.010 | 0.025 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.007 | 0.003 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.005 | 0.002 |
| Research integrity | 0.008 | 0.009 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
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".