Bibliographic record
Abstract
Introduction and Objectives: The utilization of perioperative chemotherapy for bladder cancer in the general population and the survival benefit associated with therapy is not well described.Here we report practice patterns and outcomes associated with perioperative chemotherapy in the general population of Ontario, Canada.Methods: Electronic records of treatment were linked to the populationbased Ontario Cancer Registry to identify all patients who underwent cystectomy for bladder cancer in Ontario 1994-2008.Utilization of neoadjuvant (NACT) and adjuvant (ACT) chemotherapy was compared across 3 study periods: 1994-98, 1999-03, 2004-08.Logistic regression was used to analyze factors associated with use of NACT/ACT.A Cox model and propensity score analysis was used to explore the association between ACT and survival.Results: 2738 muscle-invasive cases were identified.While use of NACT did not change substantially over the 3 study periods (5%, 3%, 6%; p=0.004), utilization of ACT increased with time (16%, 19%, 23%; p=0.001).In adjusted analyses younger age and less comorbidity were associated with greater utilization of NACT and ACT as was higher T stage and lymphovascular invasion/node positive disease (OR 7.2, 95% CI 5.5-9.5).Five year overall (OS) and cancer-specific survival (CSS) for all muscle-invasive cases were 30% (95% CI 28-31%) and 34% (95% CI 32-36%) respectively.In Cox analysis T3/T4 tumours (HR 1.7, 95% CI 1.6-2.0),node positive disease (HR 1.9, 95% CI 1.7-2.1),and lymphovascular invasion (HR 1.8, 95% CI 1.6-2.1)were independently associated with inferior OS.Utilization of ACT was associated with improved OS (HR 0.70, 95% CI 0.6-0.8)and improved CSS (HR 0.70, 95%CI 0.6-0.8).Conclusions: Despite accumulating evidence and guidelines, NACT/ACT remains substantially underutilized in routine clinical practice.Our results suggest that ACT is associated with a substantial survival benefit in the general population.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.627 | 0.318 |
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".