Risk Prediction Scores for Recurrence and Progression of Non-Muscle Invasive Bladder Cancer: An International Validation in Primary Tumours

Abstract Objective: We aimed to determine the validity of two risk scores for patients with non-muscle invasive bladder cancer in different European settings, in patients with primary tumours. Methods: We included 1,892 patients with primary stage Ta or T1 non-muscle invasive bladder cancer who underwent a transurethral resection in Spain (n = 973), the Netherlands (n = 639), or Denmark (n = 280). We evaluated recurrence-free survival and progression-free survival according to the European Organisation for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) risk scores for each patient and used the concordance index (c-index) to indicate discriminative ability. Results: The 3 cohorts were comparable according to age and sex, but patients from Denmark had a larger proportion of patients with the high stage and grade at diagnosis (p,0.01). At least one recurrence occurred in 839 (44%) patients and 258 (14%) patients had a progression during a median follow-up of 74 months. Patients from Denmark had the highest 10- year recurrence and progression rates (75% and 24%, respectively), whereas patients from Spain had the lowest rates (34% and 10%, respectively). The EORTC and CUETO risk scores both predicted progression better than recurrence with c-indices ranging from 0.72 to 0.82 while for recurrence, those ranged from 0.55 to 0.61. Conclusion: The EORTC and CUETO risk scores can reasonably predict progression, while prediction of recurrence is more difficult. New prognostic markers are needed to better predict recurrence of tumours in primary non-muscle invasive bladder cancer patients.This research received funding from the European Community's Seventh Framework program FP7/2007-2011 under grant agreement 201663 (Uromol project, http://www.uromol.eu/

In international law we (do not) trust: The persistent rejection of economic and social rights as a manifestation of cynicism

Despite a promising start in the Universal Declaration of Human Rights, economic and social rights still retain a second-class status in most national jurisdictions. What explains this reticence with which economic and social rights are (still) regarded? This chapter analyses how the sceptical gaze through which states view economic and social rights legitimises (or attempts to legitimise) government failures to provide for those members of their populace who are in most desperate need, and (unsuccessfully) masks the self-interest that pervades most of international law. The chapter commences with a brief introduction and subsequently proceeds in three subsequent parts. Section 2 demonstrates that cynicism was used as a sword to pierce the normative foundations of economic and social rights generally, and the International Covenant on Economic, Social and Cultural Rights particularly in the early days both before and after its adoption leading to economic and social rights’ lower status in the human rights family; Section 3 posits that cynicism has been relied upon as a shield to offer errant states a defence for not meeting their obligations under both international and national (constitutional) economic and social rights norms; and finally Section 4 argues that a certain amount of cynicism is inherent in the history of economic and social rights and how they advanced through the ages, but more optimistically that a light at the end of the tunnel exists because contemporary developments point to less rather than more cynicism in the area of economic and social rights in today’s world

The beginnings of nutrition : its effect on reproduction

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