AUA UniversityPentafecta and Trifecta Criteria for reporting outcomes of Radical Cystectomy for Muscle Invasaive Urothelial Bladder Cancer (MIBC).
Sources of Funding: non
Introduction
Pentafecta and trifecta provide a comprehensive approach for standardized outcome reporting of radical cystectomy.These criteria were proposed by an expert panel of fifty urologists including oncologic and functional outcomes. We aimed to assess the rate and predictors of achieving trifecta and pentafecta criteria in bladder cancer patients treated with radical cystectomy.
Methods
A retrospective analysis of a computerized database of patients treated with radical cystectomy and urinary diversion between January 2004 till January 2014 was performed. Inclusion criteria included: age ? 75, ASA score ?3, urothelial carcinoma and definitive pathology ?T3NoMo._x000D_ Trifecta criteria included: negative soft tissue surgical margin (STSM), retrieval of ? 16 lymph nodes and absence of high grade complication (GIII-V) within 90 days after surgery. Pentafecta included, in addition, time elapsed between TURBT and cystectomy < 3 months and absence of recurrence within 12 months after surgery. _x000D_ Multivariate binary logistic regression was used to evaluate the impact of age, gender, BMI, preoperative anaemia and hypoalbuminemia on achieving trifecta and pentafecta._x000D_
Results
After exclusions, a total of 822 patients were included in the study. Mean age was 59±7.9 years. Organ confined disease was seen in 572 (69.6%) patients. Pentafecta and trifecta criteria were met in 293 (35.6%) and 316 (38.4%) respectively (Table1). On univariate analysis, patients who missed trifecta and pentafecta were more likely to be older and have higher ASA score (Table-2). On multivariate analysis, high ASA score was the only predictor of achieving both pentafecta and trifecta criteria.
Conclusions
After 30-years of experience in a tertiary referral center, only one third of patients met the pentafecta. This finding may motivate us to search for new modalities for management of MIBC. Higher ASA score was the only predictor of missing trifecta or pentafecta and this should be considered during patient counseling before surgery.
Funding
non
Ahmed Mansour
Mohamed M. Elsaadany
Ahmed Mosbah
Shaaban AA
Hassan abol-enein