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

TY - JOUR

T1 - Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics

AU - König, Frederik

AU - Grossmann, Nico C

AU - Soria, Francesco

AU - D'Andrea, David

AU - Juvet, Tristan

AU - Potretzke, Aaron

AU - Djaladat, Hooman

AU - Ghoreifi, Alireza

AU - Kikuchi, Eiji

AU - Hayakawa, Nozomi

AU - Mari, Andrea

AU - Khene, Zine-Eddine

AU - Fujita, Kazutoshi

AU - Raman, Jay D

AU - Breda, Alberto

AU - Fontana, Matteo

AU - Sfakianos, John P

AU - Pfail, John L

AU - Laukhtina, Ekaterina

AU - Rajwa, Pawel

AU - Pallauf, Maximilian

AU - Cacciamani, Giovanni E

AU - van Doeveren, Thomas

AU - Boormans, Joost L

AU - Antonelli, Alessandro

AU - Jamil, Marcus

AU - Abdollah, Firas

AU - Budzyn, Jeffrey

AU - Ploussard, Guillaume

AU - Heidenreich, Axel

AU - Daneshmand, Siamak

AU - Boorjian, Stephen A

AU - Rouprêt, Morgan

AU - Rink, Michael

AU - Shariat, Shahrokh F

AU - Pradere, Benjamin

PY - 2022/3/31

Y1 - 2022/3/31

N2 - Background: Measuring quality of care indicators is important for clinicians and decision making in health care to improve patient outcomes. Objective: 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. Design: We performed a retrospective multicenter study of patients treated with RNU for EAU high-risk (HR) UTUC. Outcome measurements and statistical analysis: 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. Results: 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. Conclusions: 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.

AB - Background: Measuring quality of care indicators is important for clinicians and decision making in health care to improve patient outcomes. Objective: 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. Design: We performed a retrospective multicenter study of patients treated with RNU for EAU high-risk (HR) UTUC. Outcome measurements and statistical analysis: 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. Results: 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. Conclusions: 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.

U2 - 10.3390/cancers14071781

DO - 10.3390/cancers14071781

M3 - SCORING: Journal article

C2 - 35406553

VL - 14

JO - CANCERS

JF - CANCERS

SN - 2072-6694

IS - 7

M1 - 1781

ER -