Radical Cystectomy (RC) and Urinary Diversion (UD) is a complex surgery associated with a significant impact on health-related quality of life (HRQoL). However, HRQoL assessment is too often overlooked, with survival and complications being the most commonly investigated outcomes. This study aimed to identify the most impaired HRQoL features in patients receiving RC, compared to a healthy population (HP) control, as well as patients’ recovery after surgery, differentiating between patients receiving ORC and RARC. Patients with Bca, who were candidates for RC with curative intent, were enrolled in the “BCa cohort”. HRQoL outcomes were collected with an EORTC QLQ-C30 questionnaire. These were collected at baseline, and then at 6-, 12- and 24 mo after surgery in the BCa cohorts, and at baseline in the HP cohort. A 1:1 propensity score matched (PSM)-analysis, adjusted for age, Charlson Comorbidity Index (CCI) and smoking history, was performed. Between January 2018 and February 2023, a total of 418 patients were enrolled in the study, 116 and 302 in the BCa and HP cohorts, respectively. After applying the 1:1 propensity scored match (PSM) analysis, two homogeneous cohorts were selected, including 85 patients in each group. Baseline HRQoL assessment showed a significant impairment in terms of emotional and cognitive functioning, appetite loss and financial difficulties for the BCa cohort. Among secondary outcomes, we investigated patients’ recovery after RC and UD, comparing HRQoL outcome questionnaires between the HP and BCa cohorts at 6-, 12- and 24 mo after surgery, and a subgroup analysis was performed differentiating between patients receiving ORC and RARC with totally intracorporeal UD. Interestingly, ORC compared to RARC provided a major impact on HRQoL recovery across the early, mid and long term. In particular, the ORC cohort experienced a major impairment in terms of symptoms scales items such as fatigue, nausea and vomiting, pain and appetite loss. Consequently, comparing ORC and RARC vs. HP reported a major HRQoL impairment in the ORC cohort, possibly defining a benefit of RARC in early, mid- and long-term recovery. To conclude, this study confirmed the undeniable impact of RC on HRQoL. Interestingly, we highlighted the benefit of RARC in early, mid- and long-term recovery, expressed as less impairment of symptoms scales.
根治性膀胱切除术（RC）联合尿流改道术（UD）是一项复杂的外科手术，对健康相关生活质量（HRQoL）具有显著影响。然而，HRQoL评估常被忽视，生存率和并发症成为最常关注的研究终点。本研究旨在明确接受RC治疗的患者与健康人群（HP）对照组相比，其HRQoL受损最严重的维度，并分析患者术后恢复情况，同时区分接受开放根治性膀胱切除术（ORC）与机器人辅助根治性膀胱切除术（RARC）的患者差异。符合根治性治疗指征并计划接受RC的膀胱癌（Bca）患者被纳入“Bca队列”。采用EORTC QLQ-C30量表收集HRQoL数据：Bca队列在基线期及术后6、12、24个月进行评估，HP队列仅收集基线数据。研究采用1:1倾向评分匹配（PSM）分析，校正因素包括年龄、查尔森合并症指数（CCI）及吸烟史。2018年1月至2023年2月期间，共418例患者入组研究，其中Bca队列116例，HP队列302例。经1:1倾向评分匹配后，两组各纳入85例患者构成同质化队列。基线HRQoL评估显示，Bca队列在情绪功能、认知功能、食欲减退及经济困难维度存在显著受损。次要研究终点方面，我们通过比较HP与Bca队列在术后6、12、24个月的HRQoL量表结果，分析RC联合UD术后患者的恢复情况，并对接受ORC与完全体内尿流改道RARC的患者进行亚组分析。值得注意的是，与RARC相比，ORC对患者短期、中期及长期的HRQoL恢复均产生更大影响。具体而言，ORC队列在疲劳、恶心呕吐、疼痛及食欲减退等症状维度表现出更严重的受损。因此，对比ORC、RARC与HP的数据显示，ORC队列存在更显著的HRQoL损害，这可能提示RARC在短期、中期及长期恢复阶段具有临床获益。综上所述，本研究证实了RC对HRQoL的明确影响。值得注意的是，我们揭示了RARC在短期、中期及长期恢复阶段的优势，具体表现为症状维度受损程度更轻。
Health Related Quality of Life in Patients with Bladder Cancer Receiving a Radical Cystectomy
肿瘤(癌症)患者之家