Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement

Abstract

Background: To optimize results reporting after penile cancer (PC) surgery, we proposed a Tetrafecta and assessed its ability to predict overall survival (OS) probabilities. Methods: A purpose-built multicenter, multi-national database was queried for stage I–IIIB PC, requiring inguinal lymphadenectomy (ILND), from 2015 onwards. Kaplan–Meier (KM) method assessed differences in OS between patients achieving Tetrafecta or not. Univariable and multivariable regression analyses identified its predictors. Results: A total of 154 patients were included in the analysis. The 45 patients (29%) that achieved the Tetrafecta were younger (59 vs. 62 years; p = 0.01) and presented with fewer comorbidities (ASA score ≥ 3: 0% vs. 24%; p < 0.001). Although indicated, ILND was omitted in 8 cases (5%), while in 16, a modified template was properly used. Although median LNs yield was 17 (IQR: 11–27), 35% of the patients had <7 nodes retrieved from the groin. At Kaplan–Maier analysis, the Tetrafecta cohort displayed significantly higher OS probabilities (Log Rank = 0.01). Uni- and multivariable logistic regression analyses identified age as the only independent predictor of Tetrafecta achievement (OR: 0.97; 95%CI: 0.94–0.99; p = 0.04). Conclusions: Our Tetrafecta is the first combined outcome to comprehensively report results after PC surgery. It is widely applicable, based on standardized and reproducible variables and it predicts all-cause mortality.

Erstvorstellung des Pentafecta-Scores als Qualitätsinstrument der Outcome-Bewertung einer chirurgischen Primärtherapie an Patienten mit Peniskarzinom

“…Der von Brassetti et al entwickelte Tetrafecta-Score stellt einen wichtigen ersten Schritt zur Qualitätssicherung der primären chirurgischen Therapie von PECa-Patienten dar [4]. Aufgrund seiner bereits in der Einleitung dargelegten hybriden Grund-Komposition hinsichtlich Qualitätssicherungsinstruments einerseits und Prädiktor der Gesamtmortalität andererseits erreicht er jedoch keines der beiden Ziele vollständig.…”

“…In den letzten Jahren wurden verschiedene Scores zur Bewertung der postoperativen Ergebnisse für verschiedene urologische Tumorentitäten etabliert [1,2,3]. Brassetti et al unternahmen aktuell erstmalig den Versuch, die Qualität der chirurgischen Behandlung von Patienten mit Peniskarzinom (PECa) anhand eines Tetrafecta-Scores zu bewerten [4]. Hierfür erfassten sie die Daten einer multizentrischen Kohortenstudie von 154 Patienten mit chirurgisch behandeltem PECa in den klinischen Tumorstadien I-IIIB (American Joint Committee on Cancer/AJCC).…”

The Goal of Achieving High-Quality Surgical First-Line Therapy in Patients with Penile Cancer Is Important; However, Some Collective Efforts Are Still Required in Order to Reach It. Comment on Brassetti et al. Combined Reporting of Surgical Quality and Cancer Control after Surgical Treatment for Penile Tumors with Inguinal Lymph Node Dissection: The Tetrafecta Achievement. Curr. Oncol. 2023, 30, 1882–1892

“…We read with great interest the manuscript by Brassetti et al recently published in your journal and hope it will encourage discussion and debate around the optimization of the surgical management of patients with penile cancer (PECa) [ 1 ]. In recent years, various scores have been established to assess postsurgical outcomes for other urological tumor types [ 2 , 3 , 4 ].…”