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Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics
F. König, NC. Grossmann, F. Soria, D. D'Andrea, T. Juvet, A. Potretzke, H. Djaladat, A. Ghoreifi, E. Kikuchi, N. Hayakawa, A. Mari, ZE. Khene, K. Fujita, JD. Raman, A. Breda, M. Fontana, JP. Sfakianos, JL. Pfail, E. Laukhtina, P. Rajwa, M....
Language English Country Switzerland
Document type Journal Article
NLK
Free Medical Journals
from 2009
PubMed Central
from 2009
Europe PubMed Central
from 2009
ProQuest Central
from 2009-01-01
Open Access Digital Library
from 2009-01-01
Open Access Digital Library
from 2009-01-01
ROAD: Directory of Open Access Scholarly Resources
from 2009
- Publication type
- Journal Article MeSH
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.
Department of Urology 2nd Faculty of Medicine Charles University 11638 Prague Czech Republic
Department of Urology Comprehensive Cancer Center Medical University of Vienna 1090 Vienna Austria
Department of Urology Faculty of Medicine Kindai University Osaka 577 8502 Japan
Department of Urology Icahn School of Medicine at Mount Sinai New York NY 10029 USA
Department of Urology La Croix du Sud Hospital 31130 Toulouse France
Department of Urology Lions Gate Hospital North Vancouver BC V7L 2L7 Canada
Department of Urology Luzerner Kantonsspital 6004 Lucerne Switzerland
Department of Urology Mayo Clinic Rochester MN 55905 USA
Department of Urology Medical University of Silesia 41 808 Zabrze Poland
Department of Urology St Marianna University School of Medicine Kawasaki 216 8511 Japan
Department of Urology University Hospital Zurich 8091 Zurich Switzerland
Department of Urology University Medical Center Hamburg Eppendorf 20251 Hamburg Germany
Department of Urology University of Rennes 35000 Rennes France
Department of Urology University of Texas Southwestern Dallas TX 75390 USA
Department of Urology USC Norris Comprehensive Cancer Center Los Angeles CA 90033 USA
Department of Urology Weill Cornell Medical College New York NY 10021 USA
Hourani Center for Applied Scientific Research Al Ahliyya Amman University Amman 19328 Jordan
Institute for Urology and Reproductive Health Sechenov University 119048 Moscow Russia
Karl Landsteiner Institute of Urology and Andrology 1010 Vienna Austria
Urology Department Fundació Puigvert Autonomous University of Barcelona 08193 Barcelona Spain
Vattikuti Urology Institute Henry Ford Hospital Detroit MI 48202 USA
References provided by Crossref.org
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