Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
Clinical and Translational Science Institute, University of Rochester, Rochester, NY, 14642, USA.
Qual Life Res. 2018 Nov;27(11):2759-2775. doi: 10.1007/s11136-018-1902-8. Epub 2018 Jun 20.
The question of whether orthotopic neobladder (ONB) reconstruction is superior to ileal conduit diversion (ICD) with respect to health-related quality of life (HRQoL) remains controversial. The goal of this study is to perform a meta-analysis to compare post-ICD and post-ONB HRQoL in patients with bladder cancer.
A systematic search of Medline, Embase, the Cochrane Central Register of Controlled Trials, and the annual congress abstracts of the European Association of Urology (EAU), the American Urological Association (AUA) and the Société Internationale d'Urologie (SIU) up to June 2017 was conducted to identify all relevant clinical trials using validated questionnaires to assess HRQoL. A systematic review and meta-analysis were then performed.
A total of 2507 patients from 26 eligible studies were included. Meta-analyses showed significant differences favouring ONB patients in global health status (WMD + 9.13, p = 0.004), physical functioning (WMD + 11.57, p = 0.0001), role functioning (WMD + 9.64, p = 0.002), and social functioning (WMD + 6.81, p = 0.03) based on the EORTC-QLQ-C30 questionnaire and in the total score of FACT questionnaire (WMD + 6.80, p = 0.001). However, ONB patients were more likely to have postoperative urinary symptoms than ICD patients (WMD - 22.19, p = 0.0001).
ONB patients are more likely to have a better global health status than ICD patients. Regardless of the type of urinary diversion (UD) surgery, a gradual improvement in HRQoL over preoperative status tended to stabilise after 12 months postoperatively.
关于生活质量（HRQoL），原位新膀胱（ONB）重建是否优于回肠导管（ICD），这一问题仍存在争议。本研究旨在进行荟萃分析，比较膀胱癌患者接受 ICD 和 ONB 后 HRQoL 的差异。
系统检索 Medline、Embase、Cochrane 中央对照试验注册库，以及欧洲泌尿外科学会（EAU）、美国泌尿外科学会（AUA）和国际泌尿外科学会（SIU）年会摘要，以确定所有使用经过验证的问卷评估 HRQoL 的相关临床试验。然后进行系统评价和荟萃分析。
共有 26 项研究的 2507 名患者纳入分析。荟萃分析显示，ONB 患者在整体健康状况（WMD + 9.13，p = 0.004）、身体功能（WMD + 11.57，p = 0.0001）、角色功能（WMD + 9.64，p = 0.002）和社会功能（WMD + 6.81，p = 0.03）方面有显著差异，这是基于 EORTC-QLQ-C30 问卷得出的结果，在 FACT 问卷总分方面也有显著差异（WMD + 6.80，p = 0.001）。然而，ONB 患者术后发生尿症状的可能性高于 ICD 患者（WMD - 22.19，p = 0.0001）。
ONB 患者的整体健康状况可能优于 ICD 患者。无论采用何种尿流改道术（UD），HRQoL 在术后 12 个月内都趋于稳定，且逐渐改善，优于术前状态。
