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

Autor:	König F; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.; Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany., Grossmann NC; Department of Urology, University Hospital Zurich, 8091 Zurich, Switzerland.; Department of Urology, Luzerner Kantonsspital, 6004 Lucerne, Switzerland., Soria F; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, 10124 Turin, Italy., D'Andrea D; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria., Juvet T; Department of Urology, Lions Gate Hospital, North Vancouver, BC V7L 2L7, Canada., Potretzke A; Department of Urology, Mayo Clinic, Rochester, MN 55905, USA., Djaladat H; Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA., Ghoreifi A; Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA., Kikuchi E; Department of Urology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan., Hayakawa N; Department of Urology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan., Mari A; Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50134 Florence, Italy., Khene ZE; Department of Urology, University of Rennes, 35000 Rennes, France., Fujita K; Department of Urology, Faculty of Medicine, Kindai University, Osaka 577-8502, Japan., Raman JD; Division of Urology, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 16801, USA., Breda A; Urology Department, Fundació Puigvert, Autonomous University of Barcelona, 08193 Barcelona, Spain., Fontana M; Urology Department, Fundació Puigvert, Autonomous University of Barcelona, 08193 Barcelona, Spain., Sfakianos JP; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA., Pfail JL; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA., Laukhtina E; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.; Institute for Urology and Reproductive Health, Sechenov University, 119048 Moscow, Russia., Rajwa P; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.; Department of Urology, Medical University of Silesia, 41-808 Zabrze, Poland., Pallauf M; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.; Department of Urology, Paracelsus Medical University Salzburg, University Hospital Salzburg, 5020 Salzburg, Austria., Cacciamani GE; USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA 90007, USA., van Doeveren T; Department of Urology, Erasmus MC Cancer Institute, University Medical Center, 3015 GD Rotterdam, The Netherlands., Boormans JL; Department of Urology, Erasmus MC Cancer Institute, University Medical Center, 3015 GD Rotterdam, The Netherlands., Antonelli A; Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, 37129 Verona, Italy., Jamil M; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA., Abdollah F; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA., Budzyn J; Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI 48202, USA., Ploussard G; Department of Urology, La Croix du Sud Hospital, 31130 Toulouse, France., Heidenreich A; Department of Urology, Uro-Oncology, Robot Assisted and Specialized Urologic Surgery, University Hospital Cologne, 50937 Cologne, Germany., Daneshmand S; Department of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA., Boorjian SA; Department of Urology, Mayo Clinic, Rochester, MN 55905, USA., Rouprêt M; Urology Department, GRC n°5, Predictive Onco-Uro, AP-HP, Pitié-Salpêtrière Hospital, Sorbonne University, 75006 Paris, France., Rink M; Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany., Shariat SF; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.; Institute for Urology and Reproductive Health, Sechenov University, 119048 Moscow, Russia.; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan.; Karl Landsteiner Institute of Urology and Andrology, 1010 Vienna, Austria.; Department of Urology, Weill Cornell Medical College, New York, NY 10021, USA.; Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA.; Department of Urology, Second Faculty of Medicine, Charles University, 11638 Prague, Czech Republic., Pradere B; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria.; Department of Urology, La Croix du Sud Hospital, 31130 Toulouse, France.
Jazyk:	angličtina
Zdroj:	Cancers [Cancers (Basel)] 2022 Mar 31; Vol. 14 (7). Date of Electronic Publication: 2022 Mar 31.
DOI:	10.3390/cancers14071781
Abstrakt:	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.
Databáze:	MEDLINE
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