Atiqullah Aziz1, Michael Gierth2, Michael Rink3, Marianne Schmid3, Felix K Chun3, Roland Dahlem3, Florian Roghmann4, Rein-Jüri Palisaar4, Joachim Noldus4, Jörg Ellinger5, Stefan C Müller5, Armin Pycha6, Thomas Martini7, Christian Bolenz7, Rudolf Moritz8, Edwin Herrmann8, Bastian Keck9, Bernd Wullich9, Roman Mayr2, Hans-Martin Fritsche2, Maximilian Burger2, Patrick J Bastian10, Christian Seitz11, Sabine Brookman-May12, Evanguelos Xylinas13, Shahrokh F Shariat11, Margit Fisch3, Matthias May14. 1. Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. atiqullah.aziz@gmail.com. 2. Department of Urology, University of Regensburg, Regensburg, Germany. 3. Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. 4. Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany. 5. Department of Urology, University Hospital Bonn, Bonn, Germany. 6. Department of Urology, Central Hospital Bolzano, Bolzano, Italy. 7. Department of Urology, Mannheim Medical Centre, University of Heidelberg, Mannheim, Germany. 8. Department of Urology, University Medical Centre Münster, Münster, Germany. 9. Department of Urology, University Hospital Erlangen, Erlangen, Germany. 10. Department of Urology, Paracelsus Medical Centre Golzheim, Düsseldorf, Germany. 11. Department of Urology, Medical University of Vienna, Vienna, Austria. 12. Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany. 13. Department of Urology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France. 14. Department of Urology, St. Elisabeth Hospital, Straubing, Germany.
Abstract
UNLABELLED: Radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) is associated with heterogeneous functional and oncological outcomes. The aim of this study was to generate trifecta and pentafecta criteria to optimize outcome reporting after RC. METHODS: We interviewed 50 experts to consider a virtual group of patients (age ≤ 75 years, ASA score ≤ 3) undergoing RC for a cT2 UCB and a final histology of ≤pT3pN0M0. A ranking was generated for the three and five criteria with the highest sum score. The criteria were applied to the Prospective Multicenter Radical Cystectomy Series 2011. Multivariable binary logistic regression analyses were used to evaluate the impact of clinical and histopathological parameters on meeting the top selected criteria. RESULTS: The criteria with the highest sum score were negative soft tissue surgical margin, lymph node (LN) dissection of at least 16 LNs, no complications according to Clavien-Dindo grade 3-5 within 90 days after RC, treatment-free time between TUR-BT with detection of muscle-invasive UCB and RC <3 months and the absence of local UCB-recurrence in the pelvis ≤12 months. The first three criteria formed trifecta, and all five criteria pentafecta. A total of 334 patients qualified for final analysis, whereas 35.3 and 29 % met trifecta and pentafecta criteria, respectively. Multivariable analyses showed that the relative probability of meeting trifecta and pentafecta decreases with higher age (3.2 %, p = 0.043 and 3.3 %, p = 0.042) per year, respectively. CONCLUSIONS: Trifecta and pentafecta incorporate essential criteria in terms of outcome reporting and might be considered for the improvement of standardized quality assessment after RC for UCB.
UNLABELLED: Radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) is associated with heterogeneous functional and oncological outcomes. The aim of this study was to generate trifecta and pentafecta criteria to optimize outcome reporting after RC. METHODS: We interviewed 50 experts to consider a virtual group of patients (age ≤ 75 years, ASA score ≤ 3) undergoing RC for a cT2 UCB and a final histology of ≤pT3pN0M0. A ranking was generated for the three and five criteria with the highest sum score. The criteria were applied to the Prospective Multicenter Radical Cystectomy Series 2011. Multivariable binary logistic regression analyses were used to evaluate the impact of clinical and histopathological parameters on meeting the top selected criteria. RESULTS: The criteria with the highest sum score were negative soft tissue surgical margin, lymph node (LN) dissection of at least 16 LNs, no complications according to Clavien-Dindo grade 3-5 within 90 days after RC, treatment-free time between TUR-BT with detection of muscle-invasive UCB and RC <3 months and the absence of local UCB-recurrence in the pelvis ≤12 months. The first three criteria formed trifecta, and all five criteria pentafecta. A total of 334 patients qualified for final analysis, whereas 35.3 and 29 % met trifecta and pentafecta criteria, respectively. Multivariable analyses showed that the relative probability of meeting trifecta and pentafecta decreases with higher age (3.2 %, p = 0.043 and 3.3 %, p = 0.042) per year, respectively. CONCLUSIONS: Trifecta and pentafecta incorporate essential criteria in terms of outcome reporting and might be considered for the improvement of standardized quality assessment after RC for UCB.
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