Comparative Outcomes of Bladder Cancer in Patients Under 40 Years of Age
Bibliographic record
Abstract
Background and Objectives Bladder tumours are rare in young patients. Consequently, the literature is sparse and studies provide con-flicting reports on clinicopathological data and patient outcomes. This study examines, to our knowledge, the largest UK series of patients aged less than 40 years diagnosed with bladder cancer, and examines their risks and outcomes. Material and Methods A prospectively recorded database (2008-2018) was used to identify patients aged under 40 years diagnosed with bladder cancer. Data were retrospectively analyzed. Patients were then sub-divided into 2 groups based on age: group 1 was aged below 20 years and group 2 was aged 20–39 years. Results A total of 27 patients were identified with a median age of 34 years (range 14–39). Male to female ratio was 2.86:1. Median follow-up was 41.5 months (range 3–108). 61.9% presented with visible hematuria and 54.2% had one or more risk factors such as cigarette smoking. A total of 96.3% of patients had urothelial carcinoma and 92.3% of these were non-muscle invasive tumours. 7.7% presented with muscle invasive disease with 3.8% having positive nodes at diagnosis. Patients with non-muscle invasive urothelial tumours were risk-stratified according to the EAU-Guidelines Panel risk grouping with 39.1% low-risk, 4.3% intermediate-risk and 56.5% high-risk of recurrence and/or progression. During follow-up 30.4% recurred and 4.3% progressed to invasive disease. 23.1% underwent cystectomy and overall 11.5% died during follow-up, all due to metastatic disease. Patients in group one showed a statistically significant incidence of lower-grade disease at diagnosis with lower risk-group stratification but there was no significant difference in other parameters. Conclusion The majority of young patients in our series presented with non-muscle invasive urothelial bladder tumours but a significant proportion of these had high-risk disease. Some patients presented with aggressive, muscle invasive bladder cancer and consequently bladder cancer remains an important differential diagnosis in symptomatic patients regardless of age.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| 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".