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.

Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy

Department of Surgery S H Ho Urology Centre Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China

Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Urology AOU Città della Salute e della Scienza Torino School of Medicine Turin Italy

Department of Urology Croix Du Sud Hospital Quint Fonsegrives France

Department of Urology IRCCS Humanitas Clinical and Research Hospital Rozzano Italy

Department of Urology IRCCS Ospedale San Raffaele and Vita Salute San Raffaele University Milan Italy

Department of Urology Medical University of Vienna Vienna Austria

Department of Urology University of Jordan Amman Jordan

Department of Urology University of Texas Southwestern Medical Center Dallas TX USA

Departments of Urology Weill Cornell Medical College New York NY USA

UOC Urologia Azienda Ospedaliera Universitaria Integrata Di Verona Verona Italy

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