We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Addition of neoadjuvant chemotherapy to a 'quadrifecta' composite in radical cystectomy.
- Authors
D'Andrea, David; Soria, Francesco; Moschini, Marco; Laukhtina, Ekaterina; Hurle, Rodolfo; Mancon, Stefano; Antonelli, Alessandro; Teoh, Jeremy Yuen‐Chun; Shariat, Shahrokh F.; Pradere, Benjamin
- Abstract
Objectives: 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. Patients and Methods: 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. Results: 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). Conclusion: We propose a new pentafecta that may serve as a tool for standardising outcomes reporting and measuring the quality of RC.
- Subjects
SURGICAL margin; NEOADJUVANT chemotherapy; OVERALL survival; BLADDER cancer; LYMPH nodes
- Publication
BJU International, 2024, Vol 134, Issue 3, p459
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/bju.16331