Background

Radical cystectomy (RC) has the potential for profound changes to health-related quality of life (HRQOL).

Objective

To evaluate a broad range of HRQOL outcomes in a large RC cohort.

Design, setting, and participants

A single-center prospective study enrolled RC patients from 2008 to 2014. We collected 14 separate patient-reported outcome measures at the presurgical visit and at 3, 6, 12, 18, and 24 mo after RC.

Outcome measurements and statistical analysis

To visualize the patterns of recovery over time across domains, we used generalized estimating equations (GEEs) with nonlinear terms. Given substantial differences in patient selection for the type of urinary diversion, we separately modeled longitudinal HRQOL within conduit and continent diversion groups. The mean pre-RC scores were compared to illustrate the baseline HRQOL differences between diversion groups.

Results and limitations

The analyzed cohort included 411 patients (n = 205 ileal conduit, n = 206 continent diversion). At baseline, patients receiving continent diversion reported better mean physical (p < 0.001), urinary (p = 0.006), and sexual function (p < 0.001), but lower social function (p = 0.015). After RC, GEE modeling showed physical function scores decreasing 5/100 points by 6 mo, and subsequently stabilizing or returning to baseline. By 12 mo, social function improved by 10/100 points among continent diversions, while remaining stable among ileal conduits. Global quality of life exceeded baseline scores by 6 mo. Sexual function scores were low before RC, with limited recovery. Psychosocial domains were stable or improved, except for 10/100-point worsening of body image among ileal conduits.

Conclusions

RC patients reported favorable HRQOL recovery within 24 mo in most areas other than body image (ileal conduits) and sexual function (both). Importantly, large measurable decreases in scores were not reported by 3 mo after RC. These contemporary outcomes and the excellent locoregional control provided by RC further support it as the gold standard therapy for high-risk bladder cancer.

Patient summary

We review quality of life in the 24 mo following radical cystectomy. Large decreases in health-related quality of life were not reported, with most areas returning to, or exceeding, baseline, except for sexual function and body image.

中文翻译：

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接受根治性膀胱切除术的患者的健康相关生活质量：大型前瞻性队列的结果

背景

根治性膀胱切除术 (RC) 有可能对健康相关生活质量 (HRQOL) 产生深远的影响。

客观的

在大型 RC 队列中评估广泛的 HRQOL 结果。

设计、设置和参与者

一项单中心前瞻性研究纳入了 2008 年至 2014 年的 RC 患者。我们收集了 14 个独立的患者报告的结果测量值，这些测量值是在术前就诊时以及 RC 后 3、6、12、18 和 24 个月时进行的。

结果测量和统计分析

为了可视化跨域随时间推移的恢复模式，我们使用了具有非线性项的广义估计方程 (GEE)。鉴于尿流改道类型的患者选择存在显着差异，我们分别在导管和大陆改道组中模拟纵向 HRQOL。比较平均预 RC 分数以说明改道组之间的基线 HRQOL 差异。

结果和局限性

分析的队列包括 411 名患者（n  = 205 回肠导管，n  = 206 大陆分流）。在基线时，接受大陆转移的患者报告了更好的平均身体 ( p  < 0.001)、泌尿 ( p  = 0.006) 和性功能 ( p  < 0.001)，但社会功能较低 ( p = 0.015）。RC 后，GEE 建模显示身体功能评分在 6 个月内下降 5/100 分，随后稳定或回到基线。到 12 个月时，大陆分流中的社会功能改善了 10/100 点，而回肠管道中则保持稳定。全球生活质量超过基线得分 6 个月。RC 前性功能评分较低，恢复有限。社会心理领域稳定或有所改善，但回肠导管中身体意象恶化 10/100 分。

结论

RC 患者报告 HRQOL 在 24 个月内在身体形象（回肠导管）和性功能（两者）以外的大部分区域恢复良好。重要的是，在 RC 后 3 个月没有报告可测量的分数大幅下降。RC 提供的这些当代结果和出色的局部区域控制进一步支持它作为高危膀胱癌的金标准疗法。

患者总结

我们回顾了根治性膀胱切除术后 24 个月的生活质量。没有报告与健康相关的生活质量大幅下降，除性功能和身体形象外，大多数领域恢复或超过基线。