PD13-05 LONG-TERM ONCOLOGICAL OUTCOMES OF OFFICE-BASED FULGURATION OF TA LOW-GRADE NON MUSCLE INVASIVE BLADDER CANCER: A LARGE SINGLE CENTER SERIES
Bibliographic record
Abstract
You have accessJournal of UrologyCME1 Apr 2023PD13-05 LONG-TERM ONCOLOGICAL OUTCOMES OF OFFICE-BASED FULGURATION OF TA LOW-GRADE NON MUSCLE INVASIVE BLADDER CANCER: A LARGE SINGLE CENTER SERIES Christian Vitug, Katherine Lajkosz, Julian Chavarriaga, Andres Llano, Shayan Din, Eunice Villegas, Cynthia Kuk, Bruce Gao, Otto Hemminiki, Dhiral Kot, Jimmy Misurka, Theodorus Van Der Kwast, Christopher Wallis, Michael Jewett, Mark Soloway Aventura, Fl, Neil Fleshner, Girish Kulkarni, and Alexandre Zlotta Christian VitugChristian Vitug More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , Julian ChavarriagaJulian Chavarriaga More articles by this author , Andres LlanoAndres Llano More articles by this author , Shayan DinShayan Din More articles by this author , Eunice VillegasEunice Villegas More articles by this author , Cynthia KukCynthia Kuk More articles by this author , Bruce GaoBruce Gao More articles by this author , Otto HemminikiOtto Hemminiki More articles by this author , Dhiral KotDhiral Kot More articles by this author , Jimmy MisurkaJimmy Misurka More articles by this author , Theodorus Van Der KwastTheodorus Van Der Kwast More articles by this author , Christopher WallisChristopher Wallis More articles by this author , Michael JewettMichael Jewett More articles by this author , Mark Soloway Aventura, FlMark Soloway Aventura, Fl More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , and Alexandre ZlottaAlexandre Zlotta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sixty percent of non-muscle-invasive bladder tumors initially present as low grade (LG), which have a high recurrence rate but low risk of progression. Transurethral resection of bladder tumor (TURBT) is standard for the diagnosis, staging, and treatment of bladder cancer (BC). Office-based fulguration under local anesthesia for small, recurrent, apparent Ta LG tumors is an alternative to TURBT. It is convenient for both patients and physicians, avoiding the costs and risks of a hospital-based procedure requiring general or spinal anesthesia. However, despite being part of some guidelines, it has not become the primary management approach in part due to the paucity of large studies with long term follow-up. METHODS: We retrospectively reviewed our experience with 270 patients with a history of Ta LG BC who underwent office-based fulguration for subsequent small recurrent papillary bladder tumors between 1991 and 2021 at the Toronto General Hospital/Princess Margaret Cancer Center, University Health Network, Toronto, Canada. We report the cancer specific survival (CSS) and progression free survival (PFS, defined as muscle invasive disease or metastases). RESULTS: 270 patients with recurrent Ta LG NMIBC treated with office fulguration were included. Mean age was 64.9 (SD 13.3) years, 70.8% were men and 60.3% had single tumors. The mean number of fulgurations per patient was 3.1 (SD 3.2) with a range from 1 to 22. Median follow up was 10.1 years (IQR 5.8−16.2). Patients also underwent a mean of 3.6 (SD 3.0) TURBTs during follow-up. 44.4% of patients never received intravesical therapy during follow-up. At 10 years, the CSS was 100% and PFS was 97.3 (93.8-98.8)%, respectively. CONCLUSIONS: Our results are based on a large patient experience with long follow-up (10 years) and demonstrate that select patients with recurrent apparent Ta LG BC can be safely managed with office-based fulguration under local anesthesia, without compromising long-term oncological outcomes. This approach reduces surgical and anesthetic associated morbidity and may generate cost-savings to healthcare systems. Office-based fulguration for recurrent small tumors after Ta LG NMIBC should be more widely used. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e407 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Vitug More articles by this author Katherine Lajkosz More articles by this author Julian Chavarriaga More articles by this author Andres Llano More articles by this author Shayan Din More articles by this author Eunice Villegas More articles by this author Cynthia Kuk More articles by this author Bruce Gao More articles by this author Otto Hemminiki More articles by this author Dhiral Kot More articles by this author Jimmy Misurka More articles by this author Theodorus Van Der Kwast More articles by this author Christopher Wallis More articles by this author Michael Jewett More articles by this author Mark Soloway Aventura, Fl More articles by this author Neil Fleshner More articles by this author Girish Kulkarni More articles by this author Alexandre Zlotta More articles by this author Expand All Advertisement PDF downloadLoading ...
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 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) | 0.003 | 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 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".