To validate the pentafecta criteria proposed by the PROMETRICS group for outcome reporting after radical cystectomy in an open radical cystectomy cohort with long-term follow-up. To assess the discriminative ability of pentafecta criteria attainment for oncological endpoints.
Between 01/2009 and 12/2017, 420 patients underwent open radical cystectomy with pelvic lymph node dissection and urinary diversion for non-metastatic bladder cancer. Pentafecta criteria were defined as reported by the PROMETRICS group. The primary endpoint was pentafecta criteria attainment, oncological outcomes comprised further endpoints. We used uni- and multivariable logistic regression analysis to assess predictors of pentafecta criteria attainment. The discriminative ability of pentafecta criteria for overall mortality, cancer-specific mortality, and other-cause mortality was compared using Kaplan-Meier curves and cumulative incidence functions. After stratification by the number of pentafecta criteria attained, the association between pentafecta criteria attainment and survival endpoints was tested on multivariable Cox regression and competing-risks models.
108 (26%) fulfilled all pentafecta criteria, while 195 (46%), 77 (18%), 35 (8.3%), and five (1.2%) attained 4/5, 3/5, 2/5, ≤1/5 pentafecta criteria, respectively. Increasing age-adjusted Charlson comorbidity index (OR 0.80; p=0.015) and incontinent diversion (OR 0.38; p=0.005) were independent predictors of pentafecta criteria non-attainment. Median follow-up was 73 months. pentafecta criteria attainment (≥4/5 vs. 3/5 vs. ≤2/5 PC attained) stratified patients into groups at significantly different risk of death (p<0.001). A decreasing number of pentafecta criteria attained (<4/5) was associated with unfavorable survival estimates for both overall mortality and cancer-specific mortality (all p≤0.005) but not for other-cause mortality (all p≥0.2).
Pentafecta criteria represent accurate quality indicators for oncological outcome reporting after open radical cystectomy for non-metastatic bladder cancer with a distinct discriminative ability to predict long-term overall mortality and cancer-specific mortality.
BJU international. 2022 Sep 11 [Epub ahead of print]
Markus von Deimling, Michael Rink, Jakob Klemm, Mara Koelker, Frederik König, Philipp Gild, Maryam Khonsari, Tim A Ludwig, Phillip Marks, Roland Dahlem, Margit Fisch, Malte W Vetterlein
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.