HEALTH-RELATED QUALITY OF LIFE AFTER RADICAL CYSTECTOMY IN SURVIVED PATIENTS WITH AN ILEAL CONDUIT OR ILEAL ORTHOTOPIC NEOBLADDER DIVERSION: A COMPARATIVE PROPENSITY-SCORE MATCHED ANALYSIS

INTRODUCTION AND AIM OF THE STUDY The choice of urinary diversion (UD), after radical cystectomy (RC), affected significantly patients’ health relatedquality of life (HR-QoL). The aim of this study is to examine the different and health-related quality of life (HR-QoL) outcomes between ileal conduit (IC) and ileal orthotopic neobladder (IONB) in patients who underwent (RC) for primary bladder cancer, by using validated self-reported cancer-specific instruments. MATERIALS AND METHODS This retrospective, cross- sectional, multicenter cohort study included 148 (115 males and 33 females) and 171 (156 males and 15 females) survived patients who underwent RC with either IC or IONB respectively. HR-QoL was evaluated with Quality of Life Core Questionnaire and BLM-30 European Organization for Research and Treatment of Cancer questionnaires. Baseline HR-QoL scores were dichotomized at the median to give “good” or “poor” score profiles. A matchedpair comparative analysis was performed for comparison of HR-QoL aspects between 79 patients with IC and 79 patients with IONB. RESULTS Analysis were conducted after a median follow-up of 36 months (range 18–72). Univariate analyses showed significant differences favouring IONB in physical functioning, emotional functioning, cognitive functioning (CF), fatigue, dyspnoea, appetite loss, constipation (CO), and abdominal bloating flatulence (AB). At multivariate analyses, IONB showed better scores for emotional functioning (85 vs 79, P =.023), CF (93 vs 85, P <.001), CO (16 vs 31, P <.001), and AB (12 vs 25, P <.001).Asignificant worsening of sexual and urinary function was observed for patients with IONB in the long-term follow-up. Table 1 shows these results. At matched-pair analysis global health status was similar between the 2 groups (65 vs 62, P =.385). Significantly better scores were observed in the IONB group for the following items: CF (P =.007), fatigue (P =.003), pain (P =.019), dyspnoea (P =.016), CO (P =.001), and AB (P =.00). INTERPRETATION OF RESULTS Unique among others of this specific field, the study presents a matched-pair analysis between the type ofUDand HR-QoL, assessed using validated, cancer and bladder-specific instruments. HR-QoL of IONB patients was associated with better emotional and cognitive functions and less problems with bowel function. The global health status was affected only by the presence of severe comorbidities. Gender, age, BMI, pTMN, and follow-up length were associated with “good” HR-QoL scores. Male gender was associated with a better HR-QoL profile regarding physical functioning, nausea/ vomiting, appetite loss, and future perspective; interesting information has been extracted about gender impact on HRQoL after RC, few papers analyzed this topic(1). Urinary leakage, significantly impaired several aspects of HR-QoL, involving global health status and functional scales scores. The lower BMI was independently associated with better physical and social functioning scales. Poor nutritional status (serum albumin) was predictive of increased rate of surgical complications.ABMI >30 vs BMI <25 was associated with a 1.7 times higher rate to have postoperative complications (P =.001), the need of clean intermittent catheterization was also associated to higher BMI. Perceived QoL decreases between first and third year after surgery, as influence of optimism about success of treatment and recovery gradually declines. Due to phenomenon of adaptation a positive prolife results with a 5-year follow-up (2). Stratifying follow-up into 4 quartiles, IONB showed over time a negative impact on sexual functioning, urinary symptoms, and future perspectives, bowel function seems to improve instead. Strengths point of our study include a relatively large sample size, and the use of standardized, disease- specific HR-QoL instruments. Limitation to be considered: the study was a nonrandomized, retrospective analysis with the potential to introduce bias from confounding factors. The matched-pair analysis helped to create two comparable cohorts of patients despite the inherent baseline differences and other confounding factors linked to different UD. CONCLUSIONS IONB and IC did not show significant differences in terms of global health status. IONB provides better results in some aspects of HR-QoL mainly related to bowel function as compared with IC, but a worsening of urinary and sexual functions. Further randomized controlled trials are needed to confirm these data.