To evaluate the impact of incorporating neoadjuvant chemotherapy (NAC) into the 'quadrifecta' outcomes composite for reporting outcomes of radical cystectomy (RC) creating a pentafecta score.
This is a retrospective multicentre analysis of patients treated with RC, with or without NAC, for bladder cancer between 2002 and 2023. The primary outcome was the effect of adding NAC to a quadrifecta outcomes composite on cancer-specific (CSS) and overall survival (OS). The quadrifecta outcomes composite included a yield of ≥16 lymph nodes, negative soft tissue surgical margin, absence of major complication within 30 days from surgery, and no delay in RC.
A total of 590 patients were included in the analyses. A total of 233 (39.5%) patients achieved all quadrifecta outcomes and 82 (13.9%) patients were additionally treated with NAC, achieving the pentafecta. Achieving the quadrifecta outcomes composite was significantly associated with better CSS (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.32-0.75; P = 0.001) and OS (HR 0.48, 95% CI 0.34-0.69; P < 0.01). The addition of NAC to the quadrifecta composite outcomes significantly improved the discrimination of patients more likely to have better CSS (HR 0.21, 95% CI 0.08-0.57; P = 0.002) and OS (HR 0.26, 95% CI 0.12-0.55; P < 0.01).
We propose a new pentafecta that may serve as a tool for standardising outcomes reporting and measuring the quality of RC.
BJU international. 2024 Mar 14 [Epub ahead of print]
David D'Andrea, Francesco Soria, Marco Moschini, Ekaterina Laukhtina, Rodolfo Hurle, Stefano Mancon, Alessandro Antonelli, Jeremy Yuen-Chun Teoh, Shahrokh F Shariat, Benjamin Pradere
Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, AOU Città della Salute e della Scienza, Torino School of Medicine, Turin, Italy., Department of Urology, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Italy., UOC Urologia, Azienda Ospedaliera Universitaria Integrata Di Verona, Verona, Italy., Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, Croix Du Sud Hospital, Quint-Fonsegrives, France.