Midterm Health-related Quality of Life After Radical Cystectomy: A Propensity Score-matched Analysis

Abstract

Background: Radical cystectomy (RC) and urinary diversion affect various dimensions of patents' health-related quality of life (HRQOL). Knowledge regarding patient-reported HRQOL following RC is mainly based on retrospective findings of cross-sectional studies.

Objective: To provide data from a large prospective propensity score-matched cohort with a systematic follow-up of up to 2 yr.

Design, setting, and participants: A total of 134 consecutive patients who underwent RC and ileal conduit (IC) or orthotopic ileal neobladder (ONB) urinary diversion in a tertiary care centre were prospectively enrolled, and a propensity score matching analysis based on American Society of Anesthesiologists score, age, and tumour stage was performed. Exclusion criteria encompassed age <30 yr and RC due to benign diseases. HRQOL was addressed with the validated European Organization for Research and TREATMENT: of Cancer QLQ-C30 questionnaire. HRQOL was assessed preoperatively, and at 3, 12, and 24 mo postoperatively. Of the nondeceased patients, 85.1% (IC) and 78.2% (ONB) completed the study.

Intervention: RC.

Outcome measurements and statistical analysis: The primary endpoint was good general HRQOL based on previously published cut-off values. Secondary endpoints encompassed the respective HRQOL domains. Univariate and multivariate analyses were performed using binary logistic regression models.

Results and limitations: In the longitudinal analysis of RC patients, functioning and symptoms scores show a similar natural HRQOL course for IC and ONB patients. After 24 mo, general HRQOL was significantly higher in the ONB subcohort (60.5 vs 73.6, p=0.013). Good general HRQOL was reached by 32.4 (IC) versus 61.1% (ONB; p=0.019). In the multivariable analysis, ONB was not an independent predictor of good HRQOL (odds ratio 2.211, 95% confidence interval 0.684-7.150, p=0.185). Limitations include the nonbladder specificity of the QLQ-C30 questionnaire and the small sample size.

Conclusions: The current study provides prospective data from a unique propensity score-matched contemporary patient cohort. We display the natural history of general HRQOL and its subdomains without observing significantly higher midterm postoperative HRQOL in patients undergoing continent urinary diversion in the multivariable analysis.

Patient summary: We analyse the health-related quality of life (HRQOL) of European patients who underwent radical cystectomy due to bladder cancer and found that HRQOL was slightly better for orthotopic ileal neobladder than for ileal conduit urinary diversion after 24 mo.

Keywords: European Organization for Research and Treatment of Cancer QLQ-C30; Health-related quality of life; Radical cystectomy; Urinary diversion.