84f9daa999055e13f41dbe35ef4e2c6b 302839.pdf 382a841f9632a1a8c66537d263c4cee47ea58603 302839.pdf 87dcd3f391af63ece2598a3456b4cee91fe6d7ae572812a96647949f3526abae 302839.pdf Title: Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement Subject: Background: To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. Methods: A purpose-built multicenter, multi-national database was queried for stage I–IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan–Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. Results: A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11–27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan–Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94–0.99; p = 0.04). Conclusions: Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality. Keywords: penile cancer; inguinal lymphadenectomy; Tetrafecta; surgical quality; survival Author: Aldo Brassetti, Umberto Anceschi, Gabriele Cozzi, Julian Chavarriaga, Pavel Gavrilov, Josep Maria Gaya Sopena, Alfredo Maria Bove, Francesco Prata, Mariaconsiglia Ferriero, Riccardo Mastroianni, Leonardo Misuraca, Gabriele Tuderti, Giulia Torregiani, Marco Covotta, Diego Camacho, Gennaro Musi, Rodolfo Varela, Alberto Breda, Ottavio De Cobelli and Giuseppe Simone Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Fri Feb 3 11:42:18 2023 CET ModDate: Fri Feb 3 11:44:27 2023 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 11 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 771990 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- TRHCQL+URWPalladioL-Bold Type 1 Custom yes yes no 10 0 SCXBPA+URWPalladioL-Roma Type 1 Custom yes yes no 15 0 MXEPUJ+URWPalladioL-Ital Type 1 Custom yes yes no 19 0 HXLSFX+URWPalladioL-BoldItal Type 1 Custom yes yes no 23 0 FESTFF+CMSY10 Type 1 Builtin yes yes no 27 0 JLZORU+EURM10 Type 1 Builtin yes yes no 67 0 RIJDHR+CMBSY10 Type 1 Builtin yes yes no 74 0 GCJPGG+PalatinoLinotype,Bold CID TrueType Identity-H yes yes yes 81 0 GCKBDG+Calibri CID TrueType Identity-H yes yes yes 87 0 GCKBEG+CambriaMath CID TrueType Identity-H yes yes yes 93 0 GCJPGH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 99 0 GCJPGI+PalatinoLinotype CID TrueType Identity-H yes yes yes 102 0 GCJPGJ+PalatinoLinotype TrueType WinAnsi yes yes no 108 0 GCJPHL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 111 0 GCJPPK+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 114 0 GCKBDG+Calibri CID TrueType Identity-H yes yes yes 123 0 GCKBGG+TimesNewRoman CID TrueType Identity-H yes yes yes 129 0 GCJPGH+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 135 0 GCJPGI+PalatinoLinotype CID TrueType Identity-H yes yes yes 138 0 GCJPGJ+PalatinoLinotype TrueType WinAnsi yes yes no 144 0 GCJPHL+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 147 0 GCJPPK+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 150 0 GCKAIJ+Arial CID TrueType Identity-H yes yes yes 153 0 YDEUQH+MSAM10 Type 1 Builtin yes yes no 166 0 XAWNGI+VnURWPalladioL Type 1 Custom yes yes no 173 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-11-21 02:49:49 CET RepresentationInformation: 302839.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2024-11-20 13:45:47 CET Size: 771990 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 382 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Children: Item: Title: Study Design Destination: subsection.2.1 Item: Title: Tetrafecta Definition and Study Objective Destination: subsection.2.2 Item: Title: Statistical Analysis Destination: subsection.2.3 Item: Title: Results Destination: section.3 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement Author: Aldo Brassetti, Umberto Anceschi, Gabriele Cozzi, Julian Chavarriaga, Pavel Gavrilov, Josep Maria Gaya Sopena, Alfredo Maria Bove, Francesco Prata, Mariaconsiglia Ferriero, Riccardo Mastroianni, Leonardo Misuraca, Gabriele Tuderti, Giulia Torregiani, Marco Covotta, Diego Camacho, Gennaro Musi, Rodolfo Varela, Alberto Breda, Ottavio De Cobelli and Giuseppe Simone Subject: Background: To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. Methods: A purpose-built multicenter, multi-national database was queried for stage I IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. Results: A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11 27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94 0.99; p = 0.04). Conclusions: Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality. 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