Prognostic Value of a Trifecta for Predicting Survival Outcomes After Radical Cystectomy: A Large-Scale Multicenter Study
10.22465/juo.255000820041
- Author:
Jong Ho PARK
;
Sangchul LEE
;
Seung-Hwan JEONG
;
Ja Hyeon KU
;
Kyung Hwan KIM
;
Jong Kil NAM
;
Bumjin LIM
;
BumSik HONG
;
Wook NAM
;
Sung Gu KANG
;
Seok Ho KANG
;
Tae Gyun KWON
;
TaeHwan KIM
;
Jieun HEO
;
Won Sik HAM
;
Geehyun SONG
;
Ho Kyung SEO
;
Wan SONG
;
Hyun Hwan SUNG
;
Byong Chang JEONG
;
Jong Jin OH
- Publication Type:Original Article
- From:
Journal of Urologic Oncology
2025;23(3):268-279
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:This study aimed to evaluate the prognostic value of a trifecta, defined as negative soft tissue surgical margin (STSM), removal of ≥16 lymph nodes, and absence of major complications (Clavien-Dindo classification grade >III) within 90 days, after radical cystectomy (RC), using a large multicenter cohort.
Materials and Methods:We retrospectively analyzed data from 3,972 patients with bladder cancer who underwent RC at 11 tertiary centers in South Korea between 2003 and 2024. Survival outcomes, including overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS), were compared according to trifecta status using Kaplan-Meier and Cox regression analyses. Propensity score matching was performed to adjust for baseline differences.
Results:A total of 2,014 eligible patients were included in the final analysis, and the trifecta was achieved in 47.8%. Kaplan-Meier analysis demonstrated significantly improved 5- and 10-year OS (66.7% vs. 62.0%; 62.9% vs. 57.2%; p=0.002), CSS (79.3% vs. 75.4%; 77.8% vs. 73.8%; p=0.008), and RFS (62.7% vs. 57.6%; 60.8% vs. 55.2%; p=0.001) in the trifecta group. In multivariable analysis, trifecta achievement was significantly associated with better OS (HR, 0.813; p=0.008), CSS (HR, 0.787; p=0.017), and RFS (HR, 0.844; p=0.036). Among individual components, negative STSM showed the strongest prognostic effect across all endpoints.
Conclusions:In this large multicenter study, patients who achieved the RC trifecta exhibited significantly superior survival outcomes compared with those who did not. The trifecta may serve as a practical and standardized metric for assessing surgical quality and performance in RC. Future prospective studies are warranted to validate its prognostic and quality-assurance utility.
