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Addition of neoadjuvant chemotherapy to a 'quadrifecta' composite in radical cystectomy

D. D'Andrea, F. Soria, M. Moschini, E. Laukhtina, R. Hurle, S. Mancon, A. Antonelli, JY. Teoh, SF. Shariat, B. Pradere

. 2024 ; 134 (3) : 459-464. [pub] 20240314

Language English Country England, Great Britain

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc24019208

OBJECTIVES: To evaluate the impact of incorporating neoadjuvant chemotherapy (NAC) into the 'quadrifecta' outcomes composite for reporting outcomes of radical cystectomy (RC) creating a pentafecta score. PATIENTS AND METHODS: This is a retrospective multicentre analysis of patients treated with RC, with or without NAC, for bladder cancer between 2002 and 2023. The primary outcome was the effect of adding NAC to a quadrifecta outcomes composite on cancer-specific (CSS) and overall survival (OS). The quadrifecta outcomes composite included a yield of ≥16 lymph nodes, negative soft tissue surgical margin, absence of major complication within 30 days from surgery, and no delay in RC. RESULTS: A total of 590 patients were included in the analyses. A total of 233 (39.5%) patients achieved all quadrifecta outcomes and 82 (13.9%) patients were additionally treated with NAC, achieving the pentafecta. Achieving the quadrifecta outcomes composite was significantly associated with better CSS (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.32-0.75; P = 0.001) and OS (HR 0.48, 95% CI 0.34-0.69; P < 0.01). The addition of NAC to the quadrifecta composite outcomes significantly improved the discrimination of patients more likely to have better CSS (HR 0.21, 95% CI 0.08-0.57; P = 0.002) and OS (HR 0.26, 95% CI 0.12-0.55; P < 0.01). CONCLUSION: We propose a new pentafecta that may serve as a tool for standardising outcomes reporting and measuring the quality of RC.

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$a OBJECTIVES: To evaluate the impact of incorporating neoadjuvant chemotherapy (NAC) into the 'quadrifecta' outcomes composite for reporting outcomes of radical cystectomy (RC) creating a pentafecta score. PATIENTS AND METHODS: This is a retrospective multicentre analysis of patients treated with RC, with or without NAC, for bladder cancer between 2002 and 2023. The primary outcome was the effect of adding NAC to a quadrifecta outcomes composite on cancer-specific (CSS) and overall survival (OS). The quadrifecta outcomes composite included a yield of ≥16 lymph nodes, negative soft tissue surgical margin, absence of major complication within 30 days from surgery, and no delay in RC. RESULTS: A total of 590 patients were included in the analyses. A total of 233 (39.5%) patients achieved all quadrifecta outcomes and 82 (13.9%) patients were additionally treated with NAC, achieving the pentafecta. Achieving the quadrifecta outcomes composite was significantly associated with better CSS (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.32-0.75; P = 0.001) and OS (HR 0.48, 95% CI 0.34-0.69; P < 0.01). The addition of NAC to the quadrifecta composite outcomes significantly improved the discrimination of patients more likely to have better CSS (HR 0.21, 95% CI 0.08-0.57; P = 0.002) and OS (HR 0.26, 95% CI 0.12-0.55; P < 0.01). CONCLUSION: We propose a new pentafecta that may serve as a tool for standardising outcomes reporting and measuring the quality of RC.
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$a Soria, Francesco $u Department of Urology, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy $1 https://orcid.org/0000000184438453
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$a Moschini, Marco $u Department of Urology, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy $1 https://orcid.org/0000000230842458
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$a Laukhtina, Ekaterina $u Department of Urology, Medical University of Vienna, Vienna, Austria $1 https://orcid.org/0000000289530272
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$a Hurle, Rodolfo $u Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy
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$a Mancon, Stefano $u Department of Urology, Medical University of Vienna, Vienna, Austria $u Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy $u Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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$a Antonelli, Alessandro $u UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy $1 https://orcid.org/0000000274558803
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$a Pradere, Benjamin $u Department of Urology, Croix Du Sud Hospital, Quint-Fonsegrives, France
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