591d82dbb0a79946d6e1f629dfa804ed pmc_8997024.pdf b3eaa12d273fbd4b999bc6a85da1cb7aaf6481a0 pmc_8997024.pdf 7b4924f00c2f305b5b5a148bd3dda0c6688386344e9181c5e43382b869f575ef pmc_8997024.pdf Title: Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics Subject: 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. Keywords: nephroureterectomy; pentafecta; quality; upper tract urothelial carcinoma; UTUC Author: Frederik König, Nico C. Grossmann, Francesco Soria, David D’Andrea, Tristan Juvet, Aaron Potretzke, Hooman Djaladat, Alireza Ghoreifi, Eiji Kikuchi, Nozomi Hayakawa, Andrea Mari, Zine-Eddine Khene, Kazutoshi Fujita, Jay D. Raman, Alberto Breda, Matteo Fontana, John P. Sfakianos, John L. Pfail, Ekaterina Laukhtina, Pawel Rajwa, Maximilian Pallauf, Giovanni E. Cacciamani, Thomas van Doeveren, Joost L. Boormans, Alessandro Antonelli, Marcus Jamil, Firas Abdollah, Jeffrey Budzyn, Guillaume Ploussard, Axel Heidenreich, Siamak Daneshmand, Stephen A. Boorjian, Morgan Rouprêt, Michael Rink, Shahrokh F. Shariat and Benjamin Pradere Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Mar 31 12:03:53 2022 CEST ModDate: Thu Mar 31 12:12:58 2022 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 20 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1068970 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- FTCYWM+VnURWPalladioL Type 1 Custom yes yes no 10 0 SYSORM+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 AJXCSI+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 WTZJRH+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 DTGNSD+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 36 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 40 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 44 0 LCJEVJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 57 0 ZYGMNY+CMSY10 Type 1 Builtin yes yes no 79 0 OFEGBJ+Calibri,Bold CID TrueType Identity-H yes yes yes 98 0 OFDNDI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 104 0 OFDNDJ+PalatinoLinotype CID TrueType Identity-H yes yes yes 107 0 OFDNDK+PalatinoLinotype TrueType WinAnsi yes yes no 113 0 OFDNEL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 116 0 OFEFLL+Calibri CID TrueType Identity-H yes yes yes 119 0 OFDNDI+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 129 0 OFDNDK+PalatinoLinotype TrueType WinAnsi yes yes no 132 0 OFDNEL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 135 0 OFEFLL+Calibri CID TrueType Identity-H yes yes yes 138 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 151 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2022-05-06 02:23:17 CEST RepresentationInformation: pmc_8997024.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2022-04-26 17:56:07 CEST Size: 1068970 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 376 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Material and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Children: Item: Title: Cohort Description Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Pentafecta Criteria Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Treatment-Specific Features and Follow-Up Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Study Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Statistical Analysis Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Children: Item: Title: Baseline Clinicopathological Characteristics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Item: Title: Perioperative Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1e7c7811 Item: Title: Pentafecta Validation Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77ec78b9 Item: Title: Pathological Characteristics Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@1a3869f4 Item: Title: Oncological Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@a38d7a3 Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@77f99a05 Item: Title: Conclusions Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@63440df3 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@3aeaafa6 Info: Title: Pentafecta for Radical Nephroureterectomy in Patients with High-Risk Upper Tract Urothelial Carcinoma: A Proposal for Standardization of Quality Care Metrics Author: Frederik König, Nico C. Grossmann, Francesco Soria, David D’Andrea, Tristan Juvet, Aaron Potretzke, Hooman Djaladat, Alireza Ghoreifi, Eiji Kikuchi, Nozomi Hayakawa, Andrea Mari, Zine-Eddine Khene, Kazutoshi Fujita, Jay D. Raman, Alberto Breda, Matteo Fontana, John P. Sfakianos, John L. Pfail, Ekaterina Laukhtina, Pawel Rajwa, Maximilian Pallauf, Giovanni E. Cacciamani, Thomas van Doeveren, Joost L. Boormans, Alessandro Antonelli, Marcus Jamil, Firas Abdollah, Jeffrey Budzyn, Guillaume Ploussard, Axel Heidenreich, Siamak Daneshmand, Stephen A. Boorjian, Morgan Rouprêt, Michael Rink, Shahrokh F. Shariat and Benjamin Pradere Subject: 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. 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