Bibliographic record
Abstract
Dr. So states that based on current evidence neoadjuvant chemotherapy is associated with significant overtreatment, flawed clinical trials and a lack of consensus on a chemotherapeutic protocol. The same is true of adjuvant chemotherapy. The studies cited favouring adjuvant chemotherapy are extremely small, representing a total of only 277 patients,1,2,3,4 and the ABC group's meta-analysis has data on only 491 patients.5 These studies represent a highly selected population. In Stockle and colleagues' study,2 60% of patients were node positive. One can argue that they were actually treating early metastatic disease, where chemotherapy is known to be beneficial.6 The neoadjuvant meta-analyses represent thousands of patients in a more generalizable setting and confirm the benefits of preoperative chemotherapy.7,8 Overtreatment is a problem of any perioperative regimen. At least with neoadjuvant chemotherapy one can re-image the patient during treatment to determine if he or she is benefiting, and if not, stop chemotherapy. However, we should not use this as an excuse to forego neoadjuvant chemotherapy for fear it delays surgery. In Grossman and colleagues' trial,9 no adverse outcomes were noted by delaying surgery while chemotherapy was being administered. In reality, neoadjuvant therapy allows the patient to receive effective antineoplastic treatment while waiting for a surgical date. With regard to the optimal chemotherapy regimen, it is recognized that it should be a cisplatin-based combination treatment.7,8 Whether this is MVAC or gemcitabine and cisplatin has never been determined, and most medical oncologists accept that MVAC and gemcitabine and cisplatin are equivalent, based on the von der Maase and colleagues study on advanced disease.10 Dr. So and I both agree that neoadjuvant chemotherapy should not be offered to all patients with invasive TCCB. The key is patient selection, and this requires a multidisciplinary approach to patient care. Thus all patients warrant a preoperative medical oncology consultation to discuss the merits of neoadjuvant chemotherapy before cystectomy.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
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 teacher head, 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".