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01-12-2015 | Original Article

Optimizing outcome reporting after radical cystectomy for organ-confined urothelial carcinoma of the bladder using oncological trifecta and pentafecta

Authors: Atiqullah Aziz, Michael Gierth, Michael Rink, Marianne Schmid, Felix K. Chun, Roland Dahlem, Florian Roghmann, Rein-Jüri Palisaar, Joachim Noldus, Jörg Ellinger, Stefan C. Müller, Armin Pycha, Thomas Martini, Christian Bolenz, Rudolf Moritz, Edwin Herrmann, Bastian Keck, Bernd Wullich, Roman Mayr, Hans-Martin Fritsche, Maximilian Burger, Patrick J. Bastian, Christian Seitz, Sabine Brookman-May, Evanguelos Xylinas, Shahrokh F. Shariat, Margit Fisch, Matthias May, the PROMETRICS 2011 Research Group

Published in: World Journal of Urology | Issue 12/2015

Abstract

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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Title: Optimizing outcome reporting after radical cystectomy for organ-confined urothelial carcinoma of the bladder using oncological trifecta and pentafecta
Authors: Atiqullah Aziz
Michael Gierth
Michael Rink
Marianne Schmid
Felix K. Chun
Roland Dahlem
Florian Roghmann
Rein-Jüri Palisaar
Joachim Noldus
Jörg Ellinger
Stefan C. Müller
Armin Pycha
Thomas Martini
Christian Bolenz
Rudolf Moritz
Edwin Herrmann
Bastian Keck
Bernd Wullich
Roman Mayr
Hans-Martin Fritsche
Maximilian Burger
Patrick J. Bastian
Christian Seitz
Sabine Brookman-May
Evanguelos Xylinas
Shahrokh F. Shariat
Margit Fisch
Matthias May
the PROMETRICS 2011 Research Group
Publication date: 01-12-2015
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 12/2015
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-015-1572-x

At a glance: The STEP trials

Springer Medicine

Optimizing outcome reporting after radical cystectomy for organ-confined urothelial carcinoma of the bladder using oncological trifecta and pentafecta

Abstract

Abstract

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Abstract

Methods

Results

Conclusions

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