Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics.

Measuring quality of care indicators is important for clinicians and decision making in health care to improve patient outcomes.

The primary objective was to identify quality of care indicators for patients with upper tract urothelial carcinoma (UTUC) and to validate these in an international cohort treated with radical nephroureterectomy (RNU). The secondary objective was to assess the factors associated with failure to validate the pentafecta.

We performed a retrospective multicenter study of patients treated with RNU for EAU high-risk (HR) UTUC.

Five quality indicators were consensually approved, including a negative surgical margin, a complete bladder-cuff resection, the absence of hematological complications, the absence of major complications, and the absence of a 12-month postoperative recurrence. After multiple imputations and propensity-score matching, log-rank tests and a Cox regression were used to assess the survival outcomes. Logistic regression analyses assessed predictors for pentafecta failure.

Among the 1718 included patients, 844 (49%) achieved the pentafecta. The median follow-up was 31 months. Patients who achieved the pentafecta had superior 5-year overall- (OS) and cancer-specific survival (CSS) compared to those who did not (68.7 vs. 50.1% and 79.8 vs. 62.7%, respectively, all p < 0.001). On multivariable analyses, achieving the pentafecta was associated with improved recurrence-free survival (RFS), CSS, and OS. No preoperative clinical factors predicted a failure to validate the pentafecta.

Establishing quality indicators for UTUC may help define prognosis and improve patient care. We propose a pentafecta quality criteria in RNU patients. Approximately half of the patients evaluated herein reached this endpoint, which in turn was independently associated with survival outcomes. Extended validation is needed.

Cancers. 2022 Mar 31*** epublish ***

Frederik König, Nico C Grossmann, Francesco Soria, David D'Andrea, Tristan Juvet, Aaron Potretzke, Hooman Djaladat, Alireza Ghoreifi, Eiji Kikuchi, Nozomi Hayakawa, Andrea Mari, Zine-Eddine Khene, Kazutoshi Fujita, Jay D Raman, Alberto Breda, Matteo Fontana, John P Sfakianos, John L Pfail, Ekaterina Laukhtina, Pawel Rajwa, Maximilian Pallauf, Giovanni E Cacciamani, Thomas van Doeveren, Joost L Boormans, Alessandro Antonelli, Marcus Jamil, Firas Abdollah, Jeffrey Budzyn, Guillaume Ploussard, Axel Heidenreich, Siamak Daneshmand, Stephen A Boorjian, Morgan Rouprêt, Michael Rink, Shahrokh F Shariat, Benjamin Pradere

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria., Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, 10124 Turin, Italy., Department of Urology, Lions Gate Hospital, North Vancouver, BC V7L 2L7, Canada., Department of Urology, Mayo Clinic, Rochester, MN 55905, USA., Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA., Department of Urology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan., Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50134 Florence, Italy., Department of Urology, University of Rennes, 35000 Rennes, France., Department of Urology, Faculty of Medicine, Kindai University, Osaka 577-8502, Japan., Division of Urology, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 16801, USA., Urology Department, Fundació Puigvert, Autonomous University of Barcelona, 08193 Barcelona, Spain., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA., USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA 90007, USA., Department of Urology, Erasmus MC Cancer Institute, University Medical Center, 3015 GD Rotterdam, The Netherlands., Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37129 Verona, Italy., Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA., Department of Urology, La Croix du Sud Hospital, 31130 Toulouse, France., Department of Urology, Uro-Oncology, Robot Assisted and Specialized Urologic Surgery, University Hospital Cologne, 50937 Cologne, Germany., Urology Department, GRC n°5, Predictive Onco-Uro, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, 75006 Paris, France., Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.

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