TY - JOUR
T1 - Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma
T2 - 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
N1 - Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2022/4/1
Y1 - 2022/4/1
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.
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U2 - 10.3390/cancers14071781
DO - 10.3390/cancers14071781
M3 - Article
C2 - 35406553
AN - SCOPUS:85127554277
SN - 2072-6694
VL - 14
JO - Cancers
JF - Cancers
IS - 7
M1 - 1781
ER -