MP03-05: How does the type of urinary diversion affect health related quality of life (HRQOL) in the course of four years after radical cystectomy? - A propensity score-matched analysis

Yannic Volz, Lennert Eismann*, Benedikt Ebner, Paulo Pfitzinger, Jan-Friedrich Jokisch, Gerald Schulz, Thilo Westhofen, Alexander Karl, Boris Schlenker, Christian Stief, Alexander Kretschmer, Munich, Germany

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 remains unclear how the patient’s health-related quality of life (HRQOL) is affected by the choice of urinary diversion in long-term. The current study tries to provide further insight on the quality of life up to four years after RC.

Methods: HRQOL was assessed preoperatively, 3mo postoperatively and annually until a maximum follow-up of 48mo using the validated EORTC QLQ-C30- as well as the bladder cancer-specific FACT-BL- and QLQ-BLM30-questionnaires. The variables “age”, “ASA classification” and “cardiovascular co-morbidity” were used for a propensity-score matching. Potential predictors for decreased general HRQOL were assessed using multivariable logistic regression models.

Results: After propensity-score matching, patient cohorts were well-balanced and a total of 260 patients were included. We were able to reveal significant differences regarding preoperative QLQ-C30 symptoms and functioning scores between IC and ONB patients which diminished during the postoperative time course. Similarly, we did not observe significant differences based on bladder cancer-specific FACT-BL and QLQ-BLM HRQOL assessment including body image [48mo: 28.4 (IC) vs. 43.7 (ONB); p=0.439). General HRQOL may increase as we found increased global health status scores for ONB throughout the whole observational period without reaching statistical significance [48mo: 57.1 (IC) vs. 67.7 (ONB); p=0.200]. In multivariate analysis, cardiovascular co-morbidity was an independent predictor of impaired HRQOL 24mo (HR 2.45; CI95% 1.16-5.17, p=0.019) and 36mo (HR 4.84; CI95% 1.39-16.92, p=0.013) postoperatively.

Conclusions: Up to four years after RC we did not observe significant differences between both types of urinary diversion in bladder cancer-specific subscores as well as generic HRQOL. Consequently, the type of urinary diversion was not an independent predictor of good general HRQOL.

Source of Funding: None