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Multicenter Study
. 2023 Feb 3;30(2):1882-1892.
doi: 10.3390/curroncol30020146.

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

Aldo Brassetti  1 , Umberto Anceschi  1 , Gabriele Cozzi  2 , Julian Chavarriaga  3   4 , Pavel Gavrilov  5 , Josep Maria Gaya Sopena  5 , Alfredo Maria Bove  1 , Francesco Prata  1 , Mariaconsiglia Ferriero  1 , Riccardo Mastroianni  1 , Leonardo Misuraca  1 , Gabriele Tuderti  1 , Giulia Torregiani  6 , Marco Covotta  6 , Diego Camacho  7 , Gennaro Musi  2 , Rodolfo Varela  7 , Alberto Breda  5 , Ottavio De Cobelli  2 , Giuseppe Simone  1
Affiliations
Multicenter Study

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

Aldo Brassetti et al. Curr Oncol. .

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.

Keywords: Tetrafecta; inguinal lymphadenectomy; penile cancer; surgical quality; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Surgical outcomes and Tetrafecta rate.
Figure 2
Figure 2
Kaplan–Maier analysis to assess the predictive role of Trifecta achievement on OS probabilities.
See this image and copyright information in PMC

Comment in

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