{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T03:31:09Z","timestamp":1785209469275,"version":"3.55.0"},"reference-count":16,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T00:00:00Z","timestamp":1745107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To externally validate the tetrafecta and pentafecta frameworks for assessing the quality of radical nephroureterectomy (RNU) and their correlation with oncological outcomes in patients with localised upper tract urothelial carcinoma (UTUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>This retrospective study included 545 patients who underwent RNU for localised UTUC between 2012 and 2023 at eight French university hospitals and one Lebanese university hospital. Achievement of tetrafecta required four criteria to be met: negative surgical margins, complete bladder cuff excision, lymph node dissection (if indicated), and absence of recurrence within 12\u2009months. Pentafecta consisted of the same criteria, plus no major complications or haematological events. Oncological outcomes assessed included intravesical recurrence\u2010free survival (IVRFS), recurrence\u2010free survival (RFS), overall survival (OS) and cancer\u2010specific survival (CSS). Kaplan\u2013Meier analyses, Cox regression, and calibration plots were used to evaluate the predictive performance of the frameworks for 3\u2010year outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 29.5% of our cohort achieved tetrafecta and 34.5% achieved pentafecta. Patients meeting either of these quality care metrics demonstrated significantly improved oncological outcomes, with higher 3\u2010year OS rates (tetrafecta: 90.1% vs 74.2%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001; pentafecta: 89.4% vs 73.4%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001) and RFS rates (tetrafecta: 84.5% vs 57.6%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001; pentafecta: 83.5% vs 56%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Both metrics showed high predictive accuracy for OS (area under the curve [AUC] 0.92 for tetrafecta; 0.93 for pentafecta,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.41) and CSS (AUC 0.944 for tetrafecta; 0.945 for pentafecta,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.6018). Pentafecta achievement was independently associated with better OS and CSS in multivariable analysis (hazard ratio [HR] 0.30, 95% confidence interval [CI] 0.16\u20130.55,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001 and (HR 0.24, 95% CI 0.10\u20130.54,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tetrafecta and pentafecta are reliable tools for assessing oncological outcomes after RNU in localised UTUC. Pentafecta demonstrated stronger prognostic value for OS, particularly in high\u2010risk populations. These metrics offer a standardised framework to guide clinical decisions, evaluate surgical quality, and counsel patients about prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.16741","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:20:58Z","timestamp":1745194858000},"page":"261-270","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["External validation of current quality care metrics after radical nephroureterectomy"],"prefix":"10.1111","volume":"136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6716-6473","authenticated-orcid":false,"given":"Igor","family":"Duquesne","sequence":"first","affiliation":[{"name":"Department of Urology, Henri Mondor University Hospital Assistance Publique\u2010H\u00f4pitaux de Paris  Cr\u00e9teil France"},{"name":"Department of Urology Icahn School of Medicine at Mount Sinai  New York City New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre\u2010Etienne","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Department of Urology, Piti\u00e9 Salp\u00eatri\u00e8re University Hospital Assistance Publique\u2010H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4293-3314","authenticated-orcid":false,"given":"Mohamad Abou","family":"Chakra","sequence":"additional","affiliation":[{"name":"Department of Urology University of Illinois at Chicago  Chicago Illinois USA"},{"name":"Department of Urology Lebanese University  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Moussa","sequence":"additional","affiliation":[{"name":"Department of Urology Lebanese University  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Mansour","sequence":"additional","affiliation":[{"name":"Department of Urology, Cochin University Hospital Assistance Publique\u2010H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihnea Bogdan","family":"Borz","sequence":"additional","affiliation":[{"name":"Department of Urology, Cochin University Hospital Assistance Publique\u2010H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Duffaut","sequence":"additional","affiliation":[{"name":"Department of Urology, Tenon University Hospital Assistance Publique\u2010H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3314-1892","authenticated-orcid":false,"given":"Benoit","family":"Mesnard","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Nantes  Nantes France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7947-0395","authenticated-orcid":false,"given":"Said","family":"Ourfali","sequence":"additional","affiliation":[{"name":"Department of Urology Hospices Civils de Lyon  Lyon France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Mercier","sequence":"additional","affiliation":[{"name":"Department of Urology University Hospital of Toulouse  Toulouse France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micha\u00ebl","family":"Peyromaure","sequence":"additional","affiliation":[{"name":"Department of Urology, Cochin University Hospital Assistance Publique\u2010H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"de la Taille","sequence":"additional","affiliation":[{"name":"Department of Urology, Henri Mondor University 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