Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
World Journal of Urology Aims and scope

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Novotny V, Hakenberg OW, Wiessner D et al (2007) Perioperative complications of radical cystectomy in a contemporary series. Eur Urol 51:397–402

    Article  PubMed  Google Scholar 

  2. Mayr R, May M, Martini T et al (2012) Predictive capacity of four comorbidity indices estimating perioperative mortality after radical cystectomy for urothelial carcinoma of the bladder. BJUI 110:222–227

    Article  Google Scholar 

  3. Smaldone MC, Corcoran AT, Hayn M et al (2009) Estimating postoperative mortality and morbidity risk of radical cystectomy with continent diversion using predictor equations. J Urol 182:2619–2624

    Article  CAS  PubMed  Google Scholar 

  4. Isbarn H, Jeldres C, Zini L et al (2009) A population based assessment of perioperative mortality after cystectomy for bladder cancer. J Urol 182:70–77

    Article  PubMed  Google Scholar 

  5. Aziz A, May M, Burger M et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66:156–163

    Article  PubMed  Google Scholar 

  6. Shariat SF, Karakiewicz PI, Palapattu GS et al (2006) Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 176:2414–2422

    Article  PubMed  Google Scholar 

  7. Bianco FJ Jr, Scardino PT, Eastham JA (2005) Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (“trifecta”). Urology 66:83–94

    Article  PubMed  Google Scholar 

  8. Hung AJ, Cai J, Simmons MN, Gill IS (2013) “Trifecta” in partial nephrectomy. J Urol 189:36–42

    Article  PubMed  Google Scholar 

  9. Patel VR, Sivaraman A, Coelho RF et al (2011) Pentafecta: a new concept for reporting outcomes of robot-assisted laparoscopic radical prostatectomy. Eur Urol 59:702–707

    Article  PubMed  Google Scholar 

  10. Svatek RS, Fisher MB, Matin SF et al (2010) Risk factor analysis in a contemporary cystectomy cohort using standardized reporting methodology and adverse event criteria. J Urol 183:929–934

    Article  PubMed  Google Scholar 

  11. Shabsigh A, Korets R, Vora KC et al (2009) Defining early morbidity after radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55:164–174

    Article  PubMed  Google Scholar 

  12. Witjes JA, Compérat E, Cowan NC et al (2014) EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 65(4):778–792

    Article  PubMed  Google Scholar 

  13. Rink M, Fajkovic H, Cha EK et al (2012) Death certificates are valid for the determination of cause of death in patients with upper and lower tract urothelial carcinoma. Eur Urol 61:854–855

    Article  PubMed  Google Scholar 

  14. Novotny V, Froehner M, May M et al (2015) Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. World J Urol [Epub ahead of print]

  15. Gakis G, Ngamsri T, Rausch S et al (2015) Fluorescence-guided bladder tumour resection: impact on survival after radical cysrectomy. World J Urol [Epub ahead of print]

  16. Froehner M, Novotny V, Wirth MP et al (2014) External validation of a model to predict locoregional failure after radical cystectomy. Cancer 120(22):3584

    Article  PubMed  Google Scholar 

  17. Christodouleas JP, Baumann BC, He J et al (2014) Optimizing bladder cancer locoregional failure risk stratification after radical cystectomy using SWOG 8710. Cancer 120:1272–1280

    Article  PubMed  Google Scholar 

  18. Roth B, Wissmeyer MP, Zehnder P et al (2010) A new multimodality technique accurately maps the primary lymphatic landing sites of the bladder. Eur Urol 57:205–211

    Article  PubMed  Google Scholar 

  19. Zehnder P, Studer UE, Skinner EC et al (2011) Super extended versus extended pelvic lymph node dissection in patients undergoing radical cystectomy for bladder cancer: a comparative study. J Urol 186:1261–1268

    Article  PubMed  Google Scholar 

  20. Leissner J, Hohenfellner R, Thüroff JW, Wolf HK (2000) Lymphadenectomy in patients with transitional call carcinoma of the urinary bladder. BJU 85:817–823

    Article  CAS  Google Scholar 

  21. Sobin LH, Wittekind Ch (1997) TNM Classification of Malignant Tumours, 5th edn. Wiley-Liss, New York

    Google Scholar 

  22. May M, Herrmann E, Bolenz C et al (2011) Association between the number of dissected lymph nodes during pelvic lymphadenectomy and cancer-specific survival in patients with lymph node-negative urothelial carcinoma of the bladder undergoing radical cystectomy. Ann Surg Oncol 18:2018–2025

    Article  PubMed  Google Scholar 

  23. Gore JL, Lai J, Setodji CM, Litwin MS, Saigal CS (2009) Mortality increases when radical cystectomy is delayed more than 12 weeks: results from a Surveillance, Epidemiology, and End Results-Medicare analysis. Cancer 115:988–996

    Article  PubMed Central  PubMed  Google Scholar 

  24. Burger M, Mulders P, Witjes W (2012) Use of neoadjuvant chemotherapy for muscle-invasive bladder cancer is low among major European centres: results of a feasibility questionnaire. Eur Urol 61:1070–1071

    Article  PubMed  Google Scholar 

  25. Hedgebeth RC, Gilbert SM, He C et al (2010) Body image and bladder cancer specific quality of life in patients with ileal conduit and neobladder urinary diversions. Urology 76:671–675

    Article  Google Scholar 

  26. Takada N, Abe T, Shinohara N et al (2012) Perioperative morbidity and mortality related to radical cystectomy: a multi-institutional retrospective study in Japan. BJUI 110:756–764

    Article  Google Scholar 

  27. Schmid M, Rink M, Traumann M et al (2015) Evidence from the `PROspective MulticEnTer RadIcal Cystectomy Series 2011 (PROMETRICS 2011)` Study: How are preoperative patient characteristics associated with urinary diversion type after radical cystectomy for bladder cancer? Ann Surg Oncol 22:1032–1042

    Article  PubMed  Google Scholar 

  28. Novara G, Catto JW, Wilson T et al (2015) Systemic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol 67(3):376–401

    Article  PubMed  Google Scholar 

  29. Colombo R, Pellucchi F, Moschini M et al (2015) Fifteen-year single-center experience with three different surgical procedures of nerve-sparing cystectomy in selected organ-confined bladder cancer patients. World J Urol. doi:10.1007/s00345-015-14

    Google Scholar 

Download references

Acknowledgments

We would like to thank the following colleagues for their valuable effort in the acquisition of data within our collaborative research group PROMETRICS 2011: Georg Bartsch, Alexander Buchner, Melanie Durschnabel, Michael Froehner, Galia Georgieva, Christian Gilfrich, Murat Gördük, Marc-Oliver Grimm, Boris Hadaschik, Axel Haferkamp, Oliver W. Hakenberg, Florian Hartmann, Markus Hohenfellner, Georg Janetschek, Nicole Kraischits, Annerose Krausse, Lukas Lusuardi, Maurice Stephan Michel, Vladimir Novotny, Philipp Nuhn, Sascha Pahernik, Chris Protzel, Jan Roigas, Paul Schramek, Danijel Sikic, Christian G. Stief, Isabella Syring, Stefan Vallo, Florian Wagenlehner, Wolfgang Weidner, Manfred P. Wirth.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Author information

Author notes

    Authors and Affiliations

    1. Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

      Atiqullah Aziz, Michael Rink, Marianne Schmid, Felix K. Chun, Roland Dahlem & Margit Fisch

    2. Department of Urology, University of Regensburg, Regensburg, Germany

      Michael Gierth, Roman Mayr, Hans-Martin Fritsche & Maximilian Burger

    3. Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany

      Florian Roghmann, Rein-Jüri Palisaar & Joachim Noldus

    4. Department of Urology, University Hospital Bonn, Bonn, Germany

      Jörg Ellinger & Stefan C. Müller

    5. Department of Urology, Central Hospital Bolzano, Bolzano, Italy

      Armin Pycha

    6. Department of Urology, Mannheim Medical Centre, University of Heidelberg, Mannheim, Germany

      Thomas Martini & Christian Bolenz

    7. Department of Urology, University Medical Centre Münster, Münster, Germany

      Rudolf Moritz & Edwin Herrmann

    8. Department of Urology, University Hospital Erlangen, Erlangen, Germany

      Bastian Keck & Bernd Wullich

    9. Department of Urology, Paracelsus Medical Centre Golzheim, Düsseldorf, Germany

      Patrick J. Bastian

    10. Department of Urology, Medical University of Vienna, Vienna, Austria

      Christian Seitz & Shahrokh F. Shariat

    11. Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany

      Sabine Brookman-May

    12. Department of Urology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France

      Evanguelos Xylinas

    13. Department of Urology, St. Elisabeth Hospital, Straubing, Germany

      Matthias May

    Authors
    1. Atiqullah Aziz
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Michael Gierth
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Michael Rink
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Marianne Schmid
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Felix K. Chun
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Roland Dahlem
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Florian Roghmann
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Rein-Jüri Palisaar
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Joachim Noldus
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Jörg Ellinger
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Stefan C. Müller
      View author publications

      You can also search for this author in PubMed Google Scholar

    12. Armin Pycha
      View author publications

      You can also search for this author in PubMed Google Scholar

    13. Thomas Martini
      View author publications

      You can also search for this author in PubMed Google Scholar

    14. Christian Bolenz
      View author publications

      You can also search for this author in PubMed Google Scholar

    15. Rudolf Moritz
      View author publications

      You can also search for this author in PubMed Google Scholar

    16. Edwin Herrmann
      View author publications

      You can also search for this author in PubMed Google Scholar

    17. Bastian Keck
      View author publications

      You can also search for this author in PubMed Google Scholar

    18. Bernd Wullich
      View author publications

      You can also search for this author in PubMed Google Scholar

    19. Roman Mayr
      View author publications

      You can also search for this author in PubMed Google Scholar

    20. Hans-Martin Fritsche
      View author publications

      You can also search for this author in PubMed Google Scholar

    21. Maximilian Burger
      View author publications

      You can also search for this author in PubMed Google Scholar

    22. Patrick J. Bastian
      View author publications

      You can also search for this author in PubMed Google Scholar

    23. Christian Seitz
      View author publications

      You can also search for this author in PubMed Google Scholar

    24. Sabine Brookman-May
      View author publications

      You can also search for this author in PubMed Google Scholar

    25. Evanguelos Xylinas
      View author publications

      You can also search for this author in PubMed Google Scholar

    26. Shahrokh F. Shariat
      View author publications

      You can also search for this author in PubMed Google Scholar

    27. Margit Fisch
      View author publications

      You can also search for this author in PubMed Google Scholar

    28. Matthias May
      View author publications

      You can also search for this author in PubMed Google Scholar

    Consortia

    the PROMETRICS 2011 Research Group

    Corresponding author

    Correspondence to Atiqullah Aziz.

    Additional information

    Atiqullah Aziz and Michael Gierth have contributed equally to this work.

    Atiqullah Aziz, Michael Rink, Felix K. Chun, Evanguelos Xylinas and Shahrokh F. Shariat contributed for the Young Academic Urologists Urothelial Carcinoma Group of the European Association of Urology.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Aziz, A., Gierth, M., Rink, M. et al. Optimizing outcome reporting after radical cystectomy for organ-confined urothelial carcinoma of the bladder using oncological trifecta and pentafecta. World J Urol 33, 1945–1950 (2015). https://doi.org/10.1007/s00345-015-1572-x

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00345-015-1572-x

    Keywords

    Search

    Navigation