Sorbonne University, GRC 5, Predictive Onco-Urology, APHP, Pitié-Salpêtrière Hospital, Urology, Paris, France.
Division of Urology, Geneva University Hospitals, Geneva, Switzerland.
Nat Rev Urol. 2023 May;20(5):279-293. doi: 10.1038/s41585-022-00693-z. Epub 2023 Jan 18.
Muscle-invasive bladder cancer (MIBC) is an aggressive disease for which the gold-standard treatment is radical cystectomy (RC) in combination with cisplatin-based neoadjuvant chemotherapy. Bladder-sparing strategies such as trimodal therapy (TMT) have also emerged to improve health-related quality of life (HRQoL) of patients. However, an improved understanding of the effect of all these treatment modalities on HRQoL is essential to provide personalized patient care. Different combinations of generic, cancer-specific and bladder cancer-specific questionnaires can be used as instruments for HRQoL evaluation in patients with MIBC before and after curative treatments, which can largely affect multiple domains of HRQoL including general health as well as physical, functional, social and emotional well-being. However, diagnosis of MIBC per se is also likely to affect HRQoL, and the perspective of cure after RC or TMT could induce a return to baseline HRQoL values for most of these domains. A considerable amount of data on HRQoL after RC is available, but conflicting results have been reported regarding the effect of urinary diversion (ileal conduit or orthotopic neobladder) and surgical approach (open or robotic surgery) on patient quality of life. Data on HRQoL after TMT are scarce, and additional comparative studies including patients receiving RC (especially using ileal orthotopic neobladder) are needed.
肌层浸润性膀胱癌（MIBC）是一种侵袭性疾病，其标准治疗方法是根治性膀胱切除术（RC）联合顺铂为基础的新辅助化疗。保留膀胱的策略，如三联疗法（TMT）也已出现，以改善患者的健康相关生活质量（HRQoL）。然而，为了提供个性化的患者护理，必须深入了解所有这些治疗方式对 HRQoL 的影响。在接受根治性治疗前后，可使用通用、癌症特异性和膀胱癌特异性问卷的不同组合作为 MIBC 患者 HRQoL 评估的工具，这些问卷可在很大程度上影响 HRQoL 的多个领域，包括一般健康以及身体、功能、社会和情感健康。然而，MIBC 的诊断本身也可能影响 HRQoL，RC 或 TMT 后的治愈观点可能会使大多数这些领域的 HRQoL 值恢复到基线水平。关于 RC 后 HRQoL 的大量数据可用，但关于尿流改道（回肠造口术或原位新膀胱）和手术方法（开放或机器人手术）对患者生活质量的影响，报告的结果存在冲突。关于 TMT 后 HRQoL 的数据很少，需要进行更多的比较研究，包括接受 RC 治疗的患者（特别是使用回肠原位新膀胱）。
