MP77-13 DOWNSTAGING OF PRIMARY VS. SECONDARY MUSCLE INVASIVE BLADDER CANCER AFTER CYSTECTOMY AND ITS ASSOCIATION WITH SURVIVAL
Bibliographic record
Abstract
You have accessJournal of UrologyBladder Cancer: Invasive VI (MP77)1 May 2024MP77-13 DOWNSTAGING OF PRIMARY VS. SECONDARY MUSCLE INVASIVE BLADDER CANCER AFTER CYSTECTOMY AND ITS ASSOCIATION WITH SURVIVAL Jessica E. Caterini, Wassim Kassouf, Rodney H. Breau, Adrian Fairey, Ramana-Kumar Agnihotram, Nimira Alimohamed, Jasmir G. Nayak, Jean-Baptiste Lattouf, Michele Lodde, Ricardo Rendon, Peter Black, Girish S. Kulkarni, Peter Chung, and D. Robert Siemens Jessica E. CateriniJessica E. Caterini , Wassim KassoufWassim Kassouf , Rodney H. BreauRodney H. Breau , Adrian FaireyAdrian Fairey , Ramana-Kumar AgnihotramRamana-Kumar Agnihotram , Nimira AlimohamedNimira Alimohamed , Jasmir G. NayakJasmir G. Nayak , Jean-Baptiste LattoufJean-Baptiste Lattouf , Michele LoddeMichele Lodde , Ricardo RendonRicardo Rendon , Peter BlackPeter Black , Girish S. KulkarniGirish S. Kulkarni , Peter ChungPeter Chung , and D. Robert SiemensD. Robert Siemens View All Author Informationhttps://doi.org/10.1097/01.JU.0001009404.49693.12.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although previous studies have suggested that patients who progress to muscle-invasive bladder cancer (secondary MIBC) after previous treatment for non-invasive disease have worse outcomes than those that present de novo (primary MIBC), recent studies have been conflicting. Further, there is emerging evidence that secondary MIBC may be more resistant to peri-operative chemotherapy. This study aimed to assess differences in downstaging and association with survival outcomes in patients with primary MIBC compared to secondary MIBC in a retrospective cohort from tertiary care centres. METHODS: This retrospective multicentre study utilized the Canadian Bladder Cancer Information System (CBCIS) database, which includes patient, tumor, and treatment data from 14 centres in Canada. The main outcome from downstaging at cystectomy defined as <pT2. Cox's proportional hazards models and multivariable regression, adjusted for key patient and treatment variables, assessed factors associated with downstaging and overall survival (OS). RESULTS: During the study period 908 patients received cystectomy between January 2017 and September 2020. Patients had localized primary MIBC (n=678) or secondary MIBC (n=230). There were no differences in baseline variables based on MIBC status including sex, clinical stage, variant pathology or use of neoadjuvant chemotherapy (NAC, 47% vs. 44%, p=0.43). Post-operatively, there were differences in lymph node metastases (primary vs. secondary; 16% vs. 59%, p=0.037) and use of NAC (5 vs. 9%, p=0.016). Downstaging to <pT2 for primary MIBC was 28% vs. 14% with secondary MIBC (p<0.001) and downstaging to pT0 was 15% vs. 5%. Multivariable analysis associated with downstaging at cystectomy included urothelial (vs. variant) pathology (Odds Ratio (OR) 6.39 95% Confidence Interval (CI), 3.22-12.69), use of NAC (OR 2.23, 95% CI 1.39-3.60) and primary vs. secondary MIBC (OR 2.65, 95% CI 1.50-4.71). Lower OS was also associated with secondary vs. primary MIBC (HR, 2.90, 95% CI 1.64-5.14, p<0.0001). CONCLUSIONS: Patients with MIBC with secondary, progressed disease had decreased survival on multivariable analysis. Further, this was associated with lower downstaging rates post-cystectomy versus those with de novo, primary MIBC. While these observations are likely confounded by assessed clinical stage at the time of cystectomy, they support further work investigating the chemosensitivity of MIBC that has progressed from non-invasive disease as it may represent a more global, treatment-resistant phenotype. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1257 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jessica E. Caterini More articles by this author Wassim Kassouf More articles by this author Rodney H. Breau More articles by this author Adrian Fairey More articles by this author Ramana-Kumar Agnihotram More articles by this author Nimira Alimohamed More articles by this author Jasmir G. Nayak More articles by this author Jean-Baptiste Lattouf More articles by this author Michele Lodde More articles by this author Ricardo Rendon More articles by this author Peter Black More articles by this author Girish S. Kulkarni More articles by this author Peter Chung More articles by this author D. Robert Siemens More articles by this author Expand All Advertisement PDF downloadLoading ...
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 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".