Radical Nephroureterectomy Pentafecta as a Predictor of Upper Tract Urothelial Carcinoma Outcomes Following Radical Surgery
Annals of Surgical Oncology, cilt.33, sa.2, ss.1848-1857, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 33 Sayı: 2
- Basım Tarihi: 2026
- Doi Numarası: 10.1245/s10434-025-18411-5
- Dergi Adı: Annals of Surgical Oncology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE
- Sayfa Sayıları: ss.1848-1857
- Anahtar Kelimeler: Nephroureterectomy, Pentafecta, Quality-of-care metrics, Survival outcomes, Upper tract urothelial carcinoma
- İstanbul Medipol Üniversitesi Adresli: Evet
Özet
Introduction: Combined criteria have been used in many facets of urologic surgical care in the management of urological cancer. We aimed to validate the prognostic ability of a pentafecta related to the outcomes of radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). Patients and Methods: Data were obtained from the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) registry, a prospective multinational database. Non-metastatic UTUC patients treated with RNU were included. We adopted a pentafecta criteria of (1) negative surgical margin; (2) en bloc resection of the bladder cuff; (3) absence of major complications; (4) template-based lymph node dissection performed per European Association of Urology guidelines; and (5) absence of recurrence (urothelial and/or distant recurrence) within 12 months. Outcomes were pentafecta achievement rates and oncological outcomes, including overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier survival analyses with log-rank were performed on survival outcomes. Multivariate Cox regression was performed to identify confounders, and logistic regression was performed to identify factors that confounded the pentafecta achievement rate. Results: Overall, 1049 cases were analyzed, and pentafecta was achieved in 504 patients (48.0%). Baseline characteristics were comparable between those who achieved pentafecta versus those who did not. Pentafecta achievement was associated with OS advantage (hazard ratio [HR] 0.586, p = 0.024) and RFS advantage (HR 0.291, p = 0.001). Multivariate Cox regression analysis identified that only pentafecta achievement and advanced T stage were independent predictors of RFS and OS. A ureteric location (compared with pelvicalyceal tumor) (odds ratio [OR] 0.424, p = 0.002), multifocality (OR 0.191, p < 0.001) and open RNU (OR 0.661, p = 0.010) were predictors of pentafecta non-achievement. Conclusion: We validated a pentafecta that gauged surgical quality for RNU. Quality-of-care metrics should be promoted to unify surgical outcomes in UTUC management.