Referral and treatment rates of neoadjuvant chemotherapy in muscle-invasive bladder cancer before and after publication of a clinical practice guideline
Bibliographic record
Abstract
Introduction: The objective of this study was to compare referraland treatment rates of neoadjuvant chemotherapy for patients withmuscle-invasive bladder cancer before and after publication of aclinical practice guideline.Methods: This was a retrospective comparative cohort study of236 patients diagnosed with clinical stage ≥ T2 bladder cancerin Alberta, Canada. Patients were divided into 2 groups basedon the time of diagnosis relative to the publication of the AlbertaGenitourinary Oncology Group Clinical Practice Guideline onBladder Cancer (CPG), which recommends cisplatin-based neoadjuvantchemotherapy for muscle-invasive disease. The pre-CPGgroup included patients (n = 129) diagnosed prior to publicationof the CPG (November 1, 2002 to October 31, 2004, inclusively).The post-CPG group included patients (n = 107) diagnosed afterpublication of the CPG (November 1, 2005 to October 31, 2007).There was an accrual blackout period of 6 months before and afterthe CPG release date. The primary analysis compared the twogroups with respect to neoadjuvant chemotherapy referral rates,treatment-offered rates and treatment-administered rates.Results: Referral to medical oncology regarding neoadjuvantchemotherapy occurred in 2.3% and 23.4% of patients in thepre- and post-CPG groups, respectively (p < 0.01). Neoadjuvantchemotherapy was offered to 0.8% and 18.7% of patients in thepre- and post-CPG groups, respectively (p < 0.01). Neoadjuvantchemotherapy was administered to 0.8% and 14.0% of patients inthe pre- and post-CPG groups, respectively (p < 0.01).Interpretation: Neoadjuvant referral and treatment rates increasedafter publication of the CPG. However, overall referral and treatmentrates remained low, which warrants additional exploration.Introduction : L’objectif de l’étude était de comparer les taux derecommandation et de traitement par chimiothérapie néoadjuvantechez les patients atteints de cancer de la vessie avec envahissementmusculaire avant et après la publication d’un guide de pratiqueclinique.Méthodologie : Il s’agit ici d’une étude comparative rétrospectivede cohorte comptant 236 patients de l’Alberta, au Canada, chezqui on avait diagnostiqué un cancer de la vessie de stade cliniqueT2 ou pire. Les patients ont été répartis en 2 groupes selon que leurdiagnostic avait été posé avant ou après la publication du guidede pratique clinique sur le cancer de la vessie (GPC) de l’AlbertaGenitourinary Oncology Group, qui recommande une chimiothérapienéoadjuvante à base de cisplatine pour le traitement descas de cancer avec envahissement musculaire. Le groupe pré-GPCcomprenait des patients (n = 129) chez qui le diagnostic avaitété posé avant la publication du GPC (du 1er novembre 2002 au31 octobre 2004, inclusivement). Le groupe post-GPC incluait despatients (n = 107) chez qui le diagnostic avait été posé après lapublication du GPC (du 1er novembre 2005 au 31 octobre 2007).Une période cumulative de censure a été calculée 6 mois avant etaprès la date de publication du GPC. L’analyse préliminaire a comparéles deux groupes quant aux taux de recommandation de lachimiothérapie néoadjuvante, aux taux d’offre et d’administrationdu traitement.Résultats : La chimiothérapie néoadjuvante a été recommandée chez2,3 et 23,4 % des patients dans les groupes pré-GPC et post-GPC,respectivement (p < 0,01). Elle a été offerte à 0,8 % et 18,7 % despatients de ces mêmes groupes (p < 0,01), et administrée à 0,8 et14,0 % des patients des groupes pré-GPC et post-GPC, respectivement(p < 0,01).Interprétation : Les taux de recommandation et de traitement concernantla chimiothérapie néoadjuvante ont augmenté après lapublication du GPC, mais sont tout de même demeurés faibles,ce qui nécessite une analyse plus poussée.
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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 | 0.011 |
| 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 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".