Predictors and oncological benefits of pentafecta achievements in patients treated with laparoscopic radical cystectomy for bladder cancer
Objective:To investigate the value of achieving pentafecta outcome in laparoscopic radical cystecto-my(LRC)for Chinese patients with bladder cancer(BCa)in predicting long-term prognosis and to analyze the pre-dictive factors in achieving the pentafecta outcome.Methods:A retrospective analysis was conducted on 174 BCa patients who underwent LRC from May 2015 to April 2022 at Beijing Friendship Hospital,Beijing Shijitan Hospi-tal,and Beijing Chaoyang Hospital affiliated to Capital Medical University.The pentafecta criteria proposed by Zapała were adopted,which were:①negative surgical margins;②dissection of ≥10 lymph nodes;③no high-grade complications(Clavien-Dindo Ⅲ-Ⅴ)within 90 days after surgery;④no tumor recurrence within 1 year af-ter surgery;⑤no urinary diversion-related complications within 1 year after surgery.Patients who met all five cri-teria were considered to have achieved"pentafecta",while those who did not were included in the non-pentafecta group.To balance confounding factors,propensity scores were used for the two patient groups,and 1∶1 matc-hing was performed to compare the general data of the two groups.The Kaplan-Meier method was used to draw survival curves.Cox regression analysis was used to investigate the relationship between achieving pentafecta and the patients'overall survival(OS),cancer-specific survival(CSS)after surgery.Logistic regression analysis was performed to identify predictive factors in achieving the pentafecta outcome.Results:Of the 174 patients included,86(49.4％)achieved the pentafecta outcome.The achievement rates for negative surgical margin,dissection of 10 lymph nodes,no high-grade complications within 90 days postoperatively,no tumor recurrence within 1 year postoperatively,and no urinary diversion-related complications within 1 year postoperatively were 94.8％,75.3％,90.8％,83.3％,and 86.2％,respectively.During a median follow-up period of 48 months,42 patients died,and 40 patients experienced tumor recurrence or metastasis.There were no significant differences between the two groups in terms of age,gender,BMI,smoking history,ERAS,type of urinary diversion,operative time,intraoperative blood loss,or intraoperative blood loss.The T stage(P＜0.001),and positive lymph node rate(P＜0.001)were lower in the pentafecta group compared to the non-pentafecta group.The Kaplan-Meier survival curves revealed that the OS(P＜0.001)and CSS(P＜0.001)were significantly higher in the pentafecta group compared to the non-pentafecta group.Multivariate Cox regression analysis showed that achieving the pentafecta outcome was an independent predictor of OS(HR=0.224,95％CI:0.073-0.682,P=0.008)and CSS(HR=0.133,95％CI:0.035-0.499,P=0.003)after LRC for BCa patients.In multivariate logistic regression analy-sis,pT≥T3(OR=0.379,95％CI:0.184-0.780,P=0.008),positive lymph nodes(OR=0.153,95％CI:0.049-0.479,P=0.001)were identified as independent predictors of achieving the pentafecta outcome.Conclu-sion:The proportion of Chinese patients achieving the pentafecta outcome in LRC is similar to the international ad-vanced level.Achieving the pentafecta outcome significantly improves OS and CSS,and T stage and positive lymph nodes are independent predictors of achieving the pentafecta outcome.
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