PD38-10 STENTING VERSUS NEPHROSTOMY TUBES FOR BLADDER CANCER ASSOCIATED WITH HYDRONEPHROSIS: DOES STENTING INCREASE THE INCIDENCE OF UPPER TRACT UROTHELIAL CARCINOMA BY RETROGRADE TUMOR CELL SEEDING?
Bibliographic record
Abstract
You have accessJournal of UrologyBladder Cancer: Invasive IV (PD38)1 May 2024PD38-10 STENTING VERSUS NEPHROSTOMY TUBES FOR BLADDER CANCER ASSOCIATED WITH HYDRONEPHROSIS: DOES STENTING INCREASE THE INCIDENCE OF UPPER TRACT UROTHELIAL CARCINOMA BY RETROGRADE TUMOR CELL SEEDING? Marian S. Wettstein, Rui M. Bernardino, Harkanwal Randhawa, Jethro C. C. Kwong, Douglas C. Cheung, Khatereh Aminoltejari, Neil E. Fleshner, Alexandre R. Zlotta, and Girish S. Kulkarni Marian S. WettsteinMarian S. Wettstein , Rui M. BernardinoRui M. Bernardino , Harkanwal RandhawaHarkanwal Randhawa , Jethro C. C. KwongJethro C. C. Kwong , Douglas C. CheungDouglas C. Cheung , Khatereh AminoltejariKhatereh Aminoltejari , Neil E. FleshnerNeil E. Fleshner , Alexandre R. ZlottaAlexandre R. Zlotta , and Girish S. KulkarniGirish S. Kulkarni View All Author Informationhttps://doi.org/10.1097/01.JU.0001009424.64728.0c.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hydronephrosis in the setting of bladder cancer is not uncommon. It can be either caused by tumor-related compression of the ureter/ureteric orifice or by transurethral resection-associated periorificial tissue swelling/edema. It is possible that decompression of the hydronephrosis by stenting instead of nephrostomy tube insertion is associated with an increased incidence of upper tract urothelial carcinoma (UTUC) due to potential retrograde tumor cell seeding. However, prior evidence is conflicting. Hence, the aim of our study was to investigate the association between type of decompression and UTUC incidence during follow-up. METHODS: We designed an observational study based on bladder cancer pathology reports linked to health administrative databases within the province of Ontario, Canada. Patients who underwent transurethral resection/biopsy of a urothelial bladder cancer between January 2001 and December 2015 that received upper tract decompression by stenting or nephrostomy insertion within 7 days were included. We excluded patients who were diagnosed with UTUC between 3 years of the index date up to 7 days after the index date and followed the cohort for the occurrence of UTUCs by querying the Ontario Cancer Registry. The association between type of decompression (reference: nephrostomy tube) and time to UTUC was quantified by unadjusted and adjusted Cox proportional hazards regression analysis. Patients were censored at the date of death or at the date of the last contact with the health care system. Effected estimates are presented as hazard ratios (HR [95% confidence intervals]). RESULTS: We identified 973 patients diagnosed with bladder cancer but not with prior UTUC who underwent decompression by either stenting (48.3%, N=470) or nephrostomy tube insertion (51.7%; N=503). During a median follow-up time of 10.9 years (interquartile range: 8.7 to 14.1 years), a UTUC occurred in 55 (5.7%) patients at a median time of 20.0 months (3.4 to 56.4 months). During any time to follow-up stenting compared to nephrostomy insertion was associated with a higher incidence of UTUCs in unadjusted analysis (HR 2.30 [1.31 to 4.05). The association remained statistically significant (HR 1.85 [1.02 to 3.36]) even after adjusting for assumed confounding variables (cT stage and grade). CONCLUSIONS: Our data supports the hypothesis of retrograde tumor cell seeding in urothelial carcinomas. Although the incidence of upper tract urothelial carcinoma is low, decompression of the upper urinary tract in patients harboring bladder cancer should ideally be achieved by nephrostomy tube insertion. This study is limited by missing information on laterality of decompression and UTUC incidence. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e810 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Marian S. Wettstein More articles by this author Rui M. Bernardino More articles by this author Harkanwal Randhawa More articles by this author Jethro C. C. Kwong More articles by this author Douglas C. Cheung More articles by this author Khatereh Aminoltejari More articles by this author Neil E. Fleshner More articles by this author Alexandre R. Zlotta More articles by this author Girish S. Kulkarni 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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.012 | 0.002 |
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".