The Impact of bladder cuff management on oncologic outcomes following radical nephroureterectomy for upper tract urothelial carcinoma
Bibliographic record
Abstract
Introduction: Bladder cuff excision (BCE) is an integral component of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). While many approaches have been described, the optimal technique for BCE to provide maximal oncologic control remains unanswered. We aimed to perform a systematic review and meta-analysis to compare oncologic outcomes of different BCE techniques. Methods: The Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases were searched for studies comparing oncologic outcomes of RNU for UTUC based on different BCE approaches. Techniques for BCE were categorized as intravesical, extravesical, or endoscopic. Our primary outcomes were intravesical recurrence rate (IVR) and intravesical recurrence-free survival (IVRFS). Secondary outcomes included recurrence-free survival (RFS) and cancer-specific survival (CSS). Meta-analysis was performed to compare the recurrence rates and survival outcomes associated with different BCE techniques. Results: Forty studies assessing a total of 17 168 patients were identified for inclusion. Open intravesical BCE was associated with superior univariate IVRFS (hazard ratio [HR] 1.27, 95% confidence interval [CI] 1.13-1.42, p=0.04, I2=43%), multivariate IVRFS (HR 1.44, 95% CI 1.16-1.80, p=0.0001, I2=75%), univariate RFS (HR 2.30, 95% CI 1.04-5.10, p=0.0002, I2=71%), and multivariate CSS (HR 1.62, 95% CI 1.22-2.15, p=0.33, I2=14%) when compared to non-intravesical techniques. Subgroup analysis revealed that this difference was primarily driven by the inferiority of the open extravesical approach. Endoscopic and non-endoscopic BCE demonstrated equivalent univariate and multivariate IVRFS, RFS, and CSS. Conclusions: Open intravesical BCE is associated with superior oncologic outcomes when compared to non-intravesical techniques. This difference is primarily driven by the open intravesical approach’s superiority to the open extravesical approach. Endoscopic BCE showed equivalent outcomes when compared to non-endoscopic approaches. Prospective randomized trials can shed further light on the optimal approach to BCE.
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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 | 0.011 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.016 |
| Bibliometrics | 0.002 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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; 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".