ArticleAnnals of surgical oncology2026
Radical Nephroureterectomy Pentafecta as a Predictor of Upper Tract Urothelial Carcinoma Outcomes Following Radical Surgery.
Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionCombined 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
methodsData 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.
resultsOverall, 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.
conclusionWe validated a pentafecta that gauged surgical quality for RNU. Quality-of-care metrics should be promoted to unify surgical outcomes in UTUC management.
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