Oncological validation and discriminative ability of pentafecta criteria after open radical cystectomy

Abstract

To validate the pentafecta criteria (PC) proposed by the PROMETRICS group for outcome reporting after radical cystectomy in an open radical cystectomy (ORC) cohort with long-term follow-up and to assess the discriminative ability of PC attainment for oncological endpoints. Patients and MethodsBetween January 2009 and December 2017, 420 patients underwent ORC with pelvic lymph node dissection and urinary diversion for non-metastatic bladder cancer. The PC were defined as reported by the PROMETRICS group. The primary endpoint was PC attainment, and oncological outcomes comprised further endpoints. We used uni-and multivariable logistic regression analysis to assess predictors of PC attainment. The discriminative ability of PC for overall mortality (OM), cancer-specific mortality (CSM) and other-cause mortality (OCM) was compared using Kaplan-Meier curves and cumulative incidence functions. After stratification by the number of PC attained, the association between PC attainment and the survival endpoints was tested on multivariable Cox regression and competing-risks models. ResultsA total of 108 patients (26%) fulfilled all PC, while 195 (46%), 77 (18%), 35 (8.3%) and five (1.2%) attained 4/5, 3/5, 2/5 and ≤1/5 PC, respectively. Increasing age-adjusted Charlson comorbidity index (odds ratio [OR] 0.80, P = 0.015) and incontinent diversion (OR 0.38, P = 0.005) were independent predictors of PC non-attainment. The median follow-up was 73 months. PC attainment (≥4/5 vs 3/5 vs ≤2/5 PC attained) was used to stratify patients into groups at significantly different risk of death (P < 0.001). A decreasing number of PC attained (<4/5) was associated with unfavourable survival estimates for both OM and CSM (all P ≤ 0.005) but not for OCM (all P ≥ 0.2). ConclusionsThe PC proposed by the PROMETRICS group represent accurate quality indicators for oncological outcome reporting after ORC for non-metastatic bladder cancer and have a distinct discriminative ability to predict long-term OM and CSM.

The current role of pentafecta in the reporting of radical cystectomy outcomes: a scoping review

“…von Deimling et al tried to assess the discriminative ability of pentafecta for prediction of oncological endpoints. Interestingly, at a long follow-up of 73 months in 420 patients, the achievement of 4 out of 5 measures in pentafecta (4/5) was comparable to full PA (5/5) in survival analysis, whereas a significant difference was found after classification of PA into 3 groups (≥4/5, 3/5, and ≤2/5) with increasing 5-year OM (22%, 71% and 86%, respectively) and 5-year CSM (16%, 47%, and 81%, respectively) with decreasing number of PA (P≤0.005) ( 22 ). These results suggest that attainment of at least 4/5 elements is required to ensure adequate outcome.…”

“…The PROMETRICS and USC definitions of pentafecta were externally validated by Brassetti et al in 2019 ( 14 ). Thereafter, the PROMETRICS definition was used in one other study, but the authors replaced 90 days reported postoperative complications by only 30 days and one-year local pelvic recurrence by any clinical recurrence ( 22 ). On the other hand, the USC pentafecta was validated in 8 articles, but some changes in the definition were seen.…”