MP24-16 PREVALENCE, PREDICTORS OF EXPOSURE AND ATHEROEMBOLIC COMPLICATIONS ASSOCIATED WITH NEOADJUVANT CHEMOTHERAPY IN BLADDER CARCINOMA
Bibliographic record
Abstract
INTRODUCTION AND OBJECTIVE: Level 1 evidence supports neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) for muscle invasive bladder cancer (MIBC) with hopes of improving overall survival. Literature to date is deficient in describing real world population-based outcomes from NAC with reference towards its prevalence, time-trends, predictors of exposure and associated atheroembolic complications (ATE). We herein present the experience in Ontario (an equal access single payer system) from 2002-2018. Objective: to describe trends in the use of NAC in Ontario over a 16 year period and describe the ATE’s in bladder cancer patients treated with either NAC, adjuvant chemotherapy (AC) or RC alone. METHODS: Population-based retrospective study using procedural, hospital and billing related data via the Institute of Clinical Evaluative Sciences. Events/interventions were accrued for 2 years. Patients receiving chemotherapy for bladder metastases or trimodal therapy were excluded. Uni and multivariate analysis were used for outcome comparisons among cohorts. RESULTS: A total of 3281 patients met the inclusion criteria. Only 974/3281 (29.7%) received NAC and among those, 50% did not progress to RC. Time trend analysis showed a significant increase in the use of NAC intent and completion (from 2007 onwards, p<0.05)(Figure 1). The NAC intention-to-treat patients were younger (p<0.001) but had similar comorbidities (mean Charlson Index score (CI) of 0.57 vs 0.71, p=0.1) as compared to the RC+/-AC cohort. Patients receiving NAC whom did not progress to RC (n=490), were older (p<0.001) and more comorbid (mean CI of 0.74 vs. 0.38, p<0.0001) than those completing RC. All groups demonstrated a similar rate of events (8.2% to 12.5% p>0.05) and interventions (2.5%-4.6% p>0.05). Among all chemotherapy exposed patients, age (>75) but not CI was associated with a higher risk for ATE’s (HR 1.98, p<0.001). CONCLUSIONS: In this population-based study, 29.7% of patients were deemed candidates for NAC with half failing to progress to RC. Time trends show consistent increase with NAC intent and completion (2007 onward). Regardless of sequence of chemotherapy exposure, 8.2-12.5% experienced ATE’s with only age as a predictor of risk.Source of Funding: No source
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| 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".