Bibliographic record
Abstract
Introduction and Objectives:The standard management of upper urinary tract urothelial carcinoma (UTUC) is radical nephroureterectomy (RNU) with bladder cuff excision (BCE).Multiple methods of BCE are possible.We investigated whether any of three methods of BCE used at our institution is associated with disease recurrence or metastases.Methods: We performed a retrospective review of RNU at our institution.Three BCE methods were used: open extravesical, open intravesical via cystotomy, and transurethral incision (TUI) using an endoloop through a laparoscopic port to secure the distal ureter.We defined recurrence as any urothelial recurrence and metastases as disease recurrence outside the urothelium.Results: From January 2001 to January 2011, 112 patients underwent RNU (110 laparoscopic, 2 open) with complete data.Sixty-one, 30, and 21 patients underwent TUI, extravesical, and intravesical BCE respectively.After a median follow-up of 22 months (range 0-113), 36 (32.1%) patients developed recurrences (bladder = 34, contralateral UT = 2) and 18 (16.1%)metastases.Recurrence rates were 26.7%, 38.1%, and 32.8% in the extravesical, intravesical, and TUI groups respectively (p=0.682).Factors associated with recurrence or metastases in a univariate regression analysis were a history of bladder cancer, smoking, positive margins, lymph node status unknown (compared to negative), and concomitant CIS.In a multivariate analysis, stage, positive margins, and CIS were associated.The method of BCE was not associated with oncologic outcomes.Conclusions: These three methods of BCE appear to be equally oncologically valid.A limitation of this study is its retrospective design.Ideally, prospective studies are needed to best assess whether a particular method is superior, but the rarity of UTUC makes prospective studies unlikely.Multi-centre trials could further validate the various methods.
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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 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.819 | 0.605 |
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".