title: Optimizing outcome reporting after radical cystectomy for organ-confined urothelial carcinoma of the bladder using oncological trifecta and pentafecta.
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.
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. atiqullah.aziz@gmail.com.
authors.forename: Atiqullah
authors.initials: A
authors.lastname: Aziz
authors.affiliation: Department of Urology, University of Regensburg, Regensburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gierth
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rink
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Felix K
authors.initials: FK
authors.lastname: Chun
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Dahlem
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany.
authors.forename: Rein-Jüri
authors.initials: RJ
authors.lastname: Palisaar
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.affiliation: Department of Urology, University Hospital Bonn, Bonn, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Ellinger
authors.affiliation: Department of Urology, University Hospital Bonn, Bonn, Germany.
authors.forename: Stefan C
authors.initials: SC
authors.lastname: Müller
authors.affiliation: Department of Urology, Central Hospital Bolzano, Bolzano, Italy.
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
authors.affiliation: Department of Urology, Mannheim Medical Centre, University of Heidelberg, Mannheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Martini
authors.affiliation: Department of Urology, Mannheim Medical Centre, University of Heidelberg, Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.affiliation: Department of Urology, University Medical Centre Münster, Münster, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Moritz
authors.affiliation: Department of Urology, University Medical Centre Münster, Münster, Germany.
authors.forename: Edwin
authors.initials: E
authors.lastname: Herrmann
authors.affiliation: Department of Urology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Bastian
authors.initials: B
authors.lastname: Keck
authors.affiliation: Department of Urology, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Wullich
authors.affiliation: Department of Urology, University of Regensburg, Regensburg, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Mayr
authors.affiliation: Department of Urology, University of Regensburg, Regensburg, Germany.
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.affiliation: Department of Urology, University of Regensburg, Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urology, Paracelsus Medical Centre Golzheim, Düsseldorf, Germany.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Bastian
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Brookman-May
authors.affiliation: Department of Urology, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Department of Urology, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Department of Urology, St. Elisabeth Hospital, Straubing, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: May
mesh_terms: D000367:Age Factors; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D019459:Urothelium
keywords: Outcome; Pentafecta; Radical cystectomy; Trifecta; Urothelial carcinoma