9. QUALITY INDICATORS FOR THE MANAGEMENT OF UTUC
Evidence-based Quality Indicators (QIs) and Quality Performance Indicators (QPIs) are designed to be surrogates of good practice and, consequently, of outcomes. These evidence-based QIs and QPIs allow for the gap between efficacy and effectiveness to be narrowed, i.e. being able to bring research evidence and Guidelines recommendations into real world practice by improving compliance to them [316]. They also permit objective monitoring of the quality of care and thus facilitate quality control and service improvements.
No QIs have been proposed for the overall management of UTUC. These QIs remain to be defined for the diagnosis of UTUC as well as the treatment of low-risk or metastatic disease and further follow-up. However, several QIs have been proposed for the perioperative management of high-risk patients treated with RNU, including complete bladder cuff removal, concomitant tailored-based LND, early postoperative single bladder instillation of chemotherapy and risk-adapted delivery of neoadjuvant or adjuvant systemic treatments [317].
In addition, the achievement of an RNU-specific pentafecta, including negative surgical margins, complete bladder cuff removal, the absence of haematological or major complication, and the absence of postoperative recurrence at 12 months, has been shown to provide higher five-year OS and CSS rates [318]. Similar results have been observed with the achievement of an RNU-specific tetrafecta, including negative surgical margins, complete bladder cuff removal, Guidelines-based LND, and the absence of postoperative recurrence at 12 months [319]. Finally, in a population-based study, a hospital volume of > six patients per year treated with RNU was associated with improvement of short-term outcomes (30- and 90-day mortality) and overall long-term survival [320].