Bibliographic record
Abstract
Introduction:We aimed to determine if there is significant variation in early recurrence after transurethral resection (TURBT) surgery between sites taking part in the RESECT study (NCT05154084) after accounting for tumor characteristics. Methods:We conducted an international, multicenter, observational study.A mixed-effects logistic regression model with tumor size, tumor number, tumor grade, tumor stage as fixed effects, and site as a random effect was fitted.Cases with first, presumed non-muscle-invasive bladder cancer (NMIBC) undergoing TURBT were included.Cases were excluded if first check followup had not been completed.Sites were excluded if they did not have at least 10 cases with first check followup.Local and/or national approvals or ethical exemptions were obtained prior to commencing the study at participating sites.Results: After exclusions, 186 sites (U.K: 80; Europe: 59; North America: 18; Asia: 17; Africa 7; South America: 3; Oceania: 2) contributing a total 4597 cases (average 25 cases) were included.Median recurrence rate per site was 12% (IQR 0-22) for low-grade tumors and 27% (IQR 13-42) for high-grade tumors (Figure 1).After controlling for tumor size, number, stage, and grade (all significantly and independently associated with early recurrence) (Table 1), there was significant residual variation attributable to site (p<0.0001,intra-class correlation, 0.1).Adjustment for sites improved the regression model from an area under the receiver operating characteristic curve of 0.66 to 0.74.Initial analysis of surgical and perioperative practice showed wide variation; a mean of 75% (IQR 66-92) of cases per site had detrusor muscle resection and 42% (IQR 17-58) had use of single instillation of intravesical chemotherapy.Other differences in operative and perioperative practice were identified through surveys.Conclusions: There is significant variation in the early recurrence rate of NMIBC after TURBT surgery between sites that could not be explained by currently understood tumor features.We have identified differences in surgical technique and perioperative practice that may impact this, and further investigation is warranted to understand how these factors impact recurrence rates.
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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 | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.181 | 0.052 |
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".