Risk of metachronous upper tract urothelial carcinoma following non‐muscle‐invasive bladder cancer
Bibliographic record
Abstract
OBJECTIVE: To determine the risk and timing of metachronous upper tract urothelial carcinoma (UTUC) after non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS: In this multi-institutional retrospective cohort study involving academic and community hospitals, clinicopathological data were collected from patients with NMIBC treated between 2005 and 2022. Patients with prior or synchronous UTUC at NMIBC diagnosis were excluded. The primary outcome was time to metachronous UTUC, confirmed on pathology or upper tract imaging. Secondary objectives included determining the cumulative incidence of UTUC stratified by the European Association of Urology risk groups and UTUC risk factors identified using Fine and Gray regression, with all-cause mortality as a competing risk. RESULTS: Among 3003 patients, 1158 (39%) were low-risk, 650 (22%) intermediate-risk, 944 (31%) high-risk, and 251 (8%) very high-risk. During a median (interquartile range) follow-up of 4.9 (2.7-8.4) years, 104 patients developed UTUC. On multivariable analysis, multiple tumours were an independent predictor of UTUC (subdistribution hazard ratio 1.86, 95% confidence interval 1.24-2.80; P = 0.003). The 10-year cumulative incidence was 2.2% for low-risk, 4.4% for intermediate-risk, and 6.3% for high- and very high-risk patients. Routine imaging detected UTUC in 40% of low-risk, 58% of intermediate-risk, and 53% of high- and very high-risk patients. High-grade UTUC was found in 36% of low-risk, 63% of intermediate-risk, and 64% of high- and very high-risk patients. The majority of UTUC cases (77%) occurred within 5 years of NMIBC. CONCLUSIONS: The contemporary risk of metachronous UTUC may be lower than historical data. Our findings demonstrate that UTUC incidence is low in patients with low- and intermediate-risk NMIBC and increases in the high- and very high-risk groups. These results support current guideline recommendations to omit routine upper tract imaging in low-risk NMIBC and question its utility in intermediate-risk disease. In high-risk patients, routine imaging remains warranted, although the optimal frequency and duration are yet to be determined.
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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 | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".