Complications after neoadjuvant chemotherapy and radical cystectomy for patients with bladder cancer: A propensity score matched analysis
Bibliographic record
Abstract
INTRODUCTION: Neoadjuvant chemotherapy (NAC) in combination with radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC). We investigated the impact of NAC on postoperative complications after RC in patients with bladder cancer (BCa). METHODS: Using the recently available American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Cystectomy database, we identified adult (>18 years old) patients who underwent RC for the treatment of BCa. Patients were then dichotomized based on whether they received NAC. We performed a 1:1 propensity score matched (PSM) analysis based on demographic and perioperative covariates. Postoperative outcomes were then compared between the two matched groups. A multivariable analysis was also performed to identify if NAC was associated with any complication. RESULTS: We identified 1582 eligible patients: 913 (57.7%) in the group that did not receive NAC and 669 (42.3%) in the group that did receive NAC. Before PSM, patients in the NAC group were younger, had lower American Society of Anesthesiology (ASA) scores, had higher rates of preoperative anemia, and were more likely to undergo continent urinary diversion. Similarly, before PSM patients in the NAC group had significantly higher rates of major complications, sepsis, urinary leak/fistula, and intraoperative/postoperative blood transfusion compared to the group that did not receive NAC; however, after 1:1 PSM, we did not find any significant difference postoperative complication rates. Multivariable analysis confirmed that NAC was not associated with any complications. CONCLUSIONS: We demonstrated that NAC does not impact 30-day postoperative complications in patients undergoing RC for BCa.
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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 | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 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".