Radical Nephroureterectomy Tetrafecta: A Proposal Reporting Surgical Strategy Quality at Surgery

European Urology Open Science

B. Pradere¹  M. Borghesi²  A. Aziz³  N. Foschi⁴  G. Lucarelli⁵  A. Mari⁶  A. Antonelli⁷  A. Porreca⁸  G.M. Busetto⁹  E. Di Trapani^1,10  S. Albisinni^1,10  R. Hurle^1,10  R. Diamand^1,11  N. Longo^1,12  E. Laukhtina^1,13  J.Y. Teoh^1,14  F. Greco^1,15  L. Boeri^1,16  F. Chiancone^1,17  A. Veccia^1,18  G.I. Russo^1,19  G. Liguori^2,20  R. Autorino^2,21  N. Crisan^2,22  M. Marchioni^2,23  Francesco Soria^2,24  M. Ferro^2,25  W. Krajewski^2,25  D. D'Andrea^2,26  M. Moschini^2,27  P. Bove^2,28  O. De Cobelli^2,29  S.F. Shariat^3,30  P. Gontero^3,31 

[1] Corresponding author. Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Torino, Italy. Tel. [phone].;Department of Urology, San Carlo di Nancy Hospital, Rome, Italy;Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia;Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy;Department of Medical, Oral and Biotechnological Sciences, Urology Unit, SS. Annunziata Hospital, G. d’Annunzio University of Chieti, Chieti, Italy;Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland;Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy;Department of Urology, AORN Antonio Cardarelli, Naples, Italy;Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy;Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria;Department of Urology, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium;Department of Urology, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy;Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium;Department of Urology, München Klinik Bogenhausen, Munich, Germany;Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy;Department of Urology, University of Catania, Catania, Italy;Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy;Department of Urology, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania;Department of Urology, University of Verona, Verona, Italy;Department of Urology, Veneto Institute of Oncology (IOV), Padua, Italy;Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy;Division of Urology, Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy;Division of Urology, Department of Surgery, VCU Health System, Richmond, VA, USA;Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Torino, Italy;Division of Urology, IEO - European Institute of Oncology, IRCCS, Milan, Italy;IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy;S.H.Ho Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China;Urology Clinic, A. Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy;Urology Unit, ASST Spedali Civili Hospital, Brescia, Italy;Urology Unit, Centro Salute Uomo, Bergamo, Italy;Urology Unit, Department of Neurosciences, Reproductive Sciences, and Odontostomatology, University of Naples “Federico II”, Naples, Italy;

关键词: Tetrafecta;    Radical nephroureterectomy;    Upper tract urothelial carcinoma;    Surgical quality;    Survival;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Standardized methods for reporting surgical quality have been described for all the major urological procedures apart from radical nephroureterectomy (RNU). Objective: To propose a tetrafecta criterion for assessing the quality of RNU based on a consensus panel within the Young Association of Urology (YAU) Urothelial Group, and to test the impact of this tetrafecta in a multicenter, large contemporary cohort of patients treated with RNU for upper tract urothelial carcinoma (UTUC). Design, setting, and participants: This was a retrospective analysis of 1765 patients with UTUC treated between 2000 and 2021. Outcome measurements and statistical analysis: We interviewed the YAU Urothelial Group to propose and score a list of items to be included in the “RNU-fecta.” A ranking was generated for the criteria with the highest sum score. These criteria were applied to a large multicenter cohort of patients. Kaplan-Meier curves were built to evaluate differences in overall survival (OS) rates between groups, and a multivariable logistic regression model was used to find the predictors of achieving the RNU tetrafecta. Results and limitations: The criteria with the highest score included three surgical items such as negative soft tissue surgical margins, bladder cuff excision, lymph node dissection according to guideline recommendations, and one oncological item defined by the absence of any recurrence in ≤12 mo. These items formed the RNU tetrafecta. Within a median follow-up of 30 mo, 52.6% of patients achieved the RNU tetrafecta. The 5-yr OS rates were significantly higher for patients achieving tetrafecta than for their counterparts (76% vs 51%). Younger age, lower body mass index, and robotic approach were found to be independent predictors of tetrafecta achievement. Conversely, a higher Eastern Cooperative Oncology Group score, higher clinical stage, and bladder cancer history were inversely associated with tetrafecta. Conclusions: Herein, we present a “tetrafecta” composite endpoint that may serve as a potential tool to assess the overall quality of the RNU procedure. Pending external validation, this tool could allow a comparison between surgical series and may be useful for assessing the learning curve of the procedure as well as for evaluating the impact of new technologies in the field. Patient summary: In this study, a tetrafecta criterion was developed for assessing the surgical quality of radical nephroureterectomy in patients with upper tract urothelial carcinoma. Patients who achieved tetrafecta had higher 5-yr overall survival rates than those who did not.

【 授权许可】

Unknown