Abstract
Introduction
Radical cystectomy (RC) and urinary diversion by ileal conduit (IC) or ileal orthotopic
neobladder (ONB) is the standard-of-care for surgical treatment of muscle-invasive
bladder cancer. Yet, it is unclear how urinary diversion affects the patient's health-related
quality of life (HRQOL) in the longer-term.
Methods
HRQOL was assessed preoperatively, 3mo postoperatively and then annually until a maximum
follow-up of 48 months using the validated EORTC QLQ-C30- as well as the bladder cancer-specific
FACT-BL- and QLQ-BLM30-questionnaires. A propensity-score matching for the variables
“age,” “ASA-classification,” “cardiovascular co-morbidity,” “sex” as well as “tumor
stage,” and “preoperative physical functioning score” was performed. Hypothetical
predictors for decreased general HRQOL were analyzed using multivariable logistic
regression models.
Results
After propensity-score matching, 246 patients were analyzed. HRQOL assessment revealed
significant differences regarding preoperative QLQ-C30 symptoms which diminished during
the postoperative time course. Similarly, we did not find significant differences
based on bladder cancer-specific FACT-BL and QLQ-BLM HRQOL assessment including body
image (48 months: 29.6.4 [IC] vs. 40.7 [ONB]; P = .733). Regarding general HRQOL, we found increased global health status scores
for ONB throughout the whole observational period without reaching statistical significance
(48 months: 55.0 [IC] vs. 70.1 [ONB]; P = .079). In multivariate analysis, cardiovascular comorbidity was an independent
predictor of impaired HRQOL 24 months (HR 2.20; CI95% 1.02-5.72, P = .044) and 36 months (HR 6.84; CI95% 1.61-29.14, P = .009) postoperatively.
Conclusion
We did not observe significant differences in bladder-specific as well as generic
HRQOL in the longer-term and consequently, the type of urinary diversion was not an
independent predictor of good general HRQOL in a follow-up period of 4 years.
Keywords
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Article info
Publication history
Published online: March 06, 2022
Accepted:
March 2,
2022
Received in revised form:
March 1,
2022
Received:
November 16,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
