Bibliographic record
Abstract
Introduction: Prior randomized controlled trials comparing bladder preservation to radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) closed due to lack of accrual.Given that none are foreseen, we used propensity scores to compare trimodality therapy (TMT, maximal transurethral resection of bladder tumor followed by concurrent chemoradiation) to RC. Methods: This retrospective analysis included 722 patients with clinical stage T2-T4N0M0 MIBC urothelial carcinoma of the bladder (440RC/282TMT) who would have been eligible for both approaches, treated at three university centers from 2005-2017.All patients had solitary tumors <7 cm, no or unilateral hydronephrosis, and no extensive/multifocal carcinoma in situ.Differences in survival outcomes by treatment were evaluated using propensity scores incorporated in: 1) propensity score-matching (PSM) using logistic regression and 3:1 matching with replacement; and 2) inverse probability treatment weighting (IPTW).Results: A total of 440/1492 (29.5%) of all MIBC surgical candidates were also candidates for TMT.The matched cohort comprised of 1119 patients (837 RC vs. 282 TMT).After matching, age (71.4 vs. 71.6),cT2 stage (90.2 vs. 90.4%),hydronephrosis (11.6 vs. 9.6%), and (neo)-adjuvant chemotherapy (60.4 vs. 56.4%)were similar between groups.Salvage cystectomy was performed in 38 (13%) TMT patients.There was no difference in five-year metastatic-free survival probabilities for RC and TMT either with IPTW (74% vs. 75%,p=0.40)or PSM (78%vs.76%, p=0.62), respectively.The five-year cancer-specific survival probabilities for RC and TMT using IPTW and PSM were 81% vs. 84%, (p=0.07) and 83% vs. 85% (p=0.06),respectively.Overall survival favored TMT (IPTW 66% vs. 73%, p=0.007;PSM 72% vs. 77%, p=0.005).Outcomes for RC and TMT were not statistically different among centers for CSS and MFS (p=0.22-0.90).Conclusions: This multi-institutional study provides the best evidence to date demonstrating similar oncological outcomes between RC and TMT for select MIBC patients.
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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 | 0.006 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.389 | 0.129 |
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; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
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".