9. QUALITY INDICATORS FOR THE MANAGEMENT OF UTUC
Evidence based Quality Indicators (QIs) and Quaity Performance Indicators (QPIs) are designed to be surrogates of good practice and consequently, outcomes. They allow for the gap between efficacy and effectiveness to be narrowed, i.e., being able to bring research evidence and guideline recommendations into real world practice by improving compliance to them [302]. 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. They 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 peri-operative management of high-risk patients treated with RNU, including complete bladder cuff removal, concomitant tailored-based LND, early post-operative single bladder instillation of chemotherapy and risk-adapted delivery of neoadjuvant or adjuvant systemic treatments [303].
In addition, the achievement of an RNU-specific pentafecta including negative surgical margins, complete bladder cuff removal, the absence of hematological or major complication and the absence of post-operative recurrence at twelve months has been shown to provide higher five year OS and CSS rates [304]. 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 post-operative recurrence at twelve months [305]. Finally, a hospital volume of > 6 patients per year treated with RNU was associated with improvement of short-term outcomes (30- and 90-day mortality) and overall long-term survival in a population-based study [306].