PD57-12 ROLE OF ROUTINE BIOPSY AFTER RADIATION-BASED THERAPY FOR MUSCLE-INVASIVE BLADDER CANCER
Bibliographic record
Abstract
INTRODUCTION AND OBJECTIVES: Mortality of Radical cystectomy (RC) differs in the literature from as low as 2.3% for a 90day mortality in a single institution, to as high as 7.9% for a prospective multi-institutional series or 5% for a retrospective review of administrative population-based database.90-day mortality rate of RC in a nation-wide population-based study has not been explored.The aim of this study is to investigate 90-day mortality rate of RC for bladder cancer in a nation-wide population-based study, and to evaluate the effect of number of RC per hospital on the surgical outcomes.METHODS: We used mandatory hospital discharge forms (CMBD) of all patients submitted to RC due to bladder cancer in Spain during 2011-2015.Morbidity and mortality were assessed using discharge codes of the primary admission or any other registered admission up to 3 months after the procedure.Demographics of patients including age, sex, and Charlson comorbidity score as well as hospital size and number of RCs/year have also been recorded.We calculated in-hospital, 30-, 60-and 90-day mortality.Average annual RC volume was used as a continuous variable (logtransformed) and also grouped into deciles in order to identify any potential non-linear relationships.Logistic regression model with mixed effect was performed adjusting for year of surgery, comorbidity, surgical approach, type of admission, age, sex, and hospital size.RESULTS: A total of 12154 RC were operated on in 196 hospitals.87.2% of the patients were males, mean age was 68.1 years (SD 9.8).88.9% of the cases received open surgery, 10% laparoscopic surgery and 1.2% robot-assisted surgery.Most hospitals (110) performed <[ 10 RC/year whereas only 5 did more than 38/year.30-, 60-and 90-day mortality rates of the series were 2.9%, 5.1% and 6.5%, respectively.Lowest mortality rates (3.3% at 90 days) are achieved in hospitals doing more than 38 cases per year.The 90-day adjusted mortality rate is associated with annual average RC volume with a 20.6% decrease per 10 extra RCs /year (95% CI 12.3%-28.1%p<0.001).High Charlson comorbidity index, advanced age, and open surgical approach were the clinical variables associated with higher mortality.CONCLUSIONS: In the setting of a nation-wide populationbased study we report a mortality rate comparable to previous multiinstitutional studies.Our study identifies an inverse association between 90-day mortality and hospital volume.The lack of centralization for RC is of concern in that low-volume centers have a mortality higher than high-volume centers.This would have a more pronounced benefit for patients at high-risk.
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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 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.074 | 0.026 |
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".