Resultados oncológicos de pacientes con afectación ganglionar tras quimioterapia neoadyuvante y cistectomía radical para el cáncer de vejiga músculo-invasivo: estudio observacional multicéntrico del Grupo de Trabajo de Carcinoma Urotelial de la sección de Jóvenes Urólogos Académicos de la Asociación Europea de Urología (YAU-EAU)
Bibliographic record
Abstract
Hasta hace poco tiempo no existía una terapia adyuvante recomendada para pacientes con metástasis en los ganglios linfáticos (ypN+) después de la quimioterapia neoadyuvante (QNA) y la cistectomía radical (CR) para el cáncer de vejiga músculo-invasivo (CVMI). El objetivo del estudio fue describir los resultados oncológicos de los pacientes ypN+ tras QNA y CR para CVMI. Este estudio retrospectivo colaborativo incluyó a 195 pacientes con enfermedad ypN+ después de QNA seguida de CR y disección bilateral de ganglios linfáticos pélvicos para el CVMI en 7 centros entre 2000 y 2019. Se recopilaron los datos demográficos y las características clínicas y patológicas de los pacientes. Se realizaron análisis de supervivencia con estimaciones de Kaplan-Meier y se generó un modelo de Cox. En total, 120 (62%) pacientes fueron pN1, 51 (26%) pN2 y 24 (12%) pN3. Se realizó radioterapia adyuvante en 18 (9%), quimioterapia adyuvante en 40 (21%), y los 137 pacientes restantes (70%) fueron sometidos a observación. La mediana del tiempo de seguimiento fue de 51 meses (IC 95%: 44-62). La mediana de la supervivencia libre de recurrencia, la supervivencia específica al cáncer y la supervivencia global (SG) fue de 18 meses (IC 95%: 16-21), 47 meses (IC 95%: 31-70) y 28 meses (IC 95%: 22-34), respectivamente. En el análisis multivariable, el sexo femenino (HR: 1,5; IC 95%: 1,002-2,21; p = 0,049) y los márgenes quirúrgicos positivos (HR: 1,6; IC 95%: 1,06-2,38; p = 0,026) fueron los únicos factores predictivos independientes de la SG. El tipo de tratamiento adyuvante no influyó en la SG (quimioterapia adyuvante, p = 0,44; radioterapia adyuvante, p = 0,40). Los resultados de supervivencia de los pacientes con CVMI y afectación ganglionar residual tras la QNA y la CR son desfavorecedores. El sexo femenino y los márgenes positivos en la CR se asocian a un pronóstico peor. Estos resultados pueden ser útiles para el diseño de ensayos clínicos a futuro. Until recently there was no recommended adjuvant therapy for patients with lymph nodes metastasis (ypN+) following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). The aim of the study was to describe the oncological outcomes of ypN+ patients following NAC and RC for MIBC. This collaborative retrospective study included 195 patients with ypN+ disease after NAC followed by RC and bilateral pelvic lymph node dissection for MIBC between 2000 and 2019 in seven centers. Patients’ demographics, clinical and pathological features were collected. Survival analyses were carried out with Kaplan-Meier estimates and a Cox model was generated. A total of 120 patients (62%) were pN1, 51 pN2 (26%) and 24 pN3 (12%). Adjuvant radiation therapy was performed in 18 (9%), adjuvant chemotherapy in 40 (21%) and the remaining 137 (70%) patients were observed. The median follow-up time was 51 months (95% CI: 44-62). Median times for recurrence-free survival, cancer-specific survival and overall survival (OS) were 18 months (95% CI: 16-21), 47 months (95% CI: 31-70) and 28 months (95% CI: 22-34) respectively. On multivariable analysis, female gender (HR: 1.5, 95% CI: 1.002-2.21, P = .049) and positive surgical margins (HR: 1.6, 95% CI: 1.06-2.38, P = .026) were the only independent predictor of OS. The type of adjuvant therapy did not impact OS (adjuvant chemotherapy, P = .44; adjuvant radiotherapy, P = .40). MIBC patients with residual node positive disease following NAC and RC have poor survival outcomes. Females and patients with positive margin status at RC carry a poorer prognosis. These results may be beneficial for clinical trial design.
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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.006 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.002 | 0.000 |
| Research integrity | 0.003 | 0.005 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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; both teacher heads 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".