Pyrgidis Nikolaos, Schulz Gerald Bastian, Ebner Benedikt, Jokisch Friedrich, Eismann Lennert, Karatas Deniz, Fouladgar Sarah Takayama, Hermans Julian, Keller Patrick, Stief Christian, Volz Yannic
Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany.
J Clin Med. 2024 Oct 13;13(20):6102. doi: 10.3390/jcm13206102.
Radical cystectomy (RC) with the formation of an ileal orthotopic neobladder (ONB) may adversely affect long-term health-related quality of life (HRQOL). An advanced age at the time of ONB construction could further exacerbate the decline in HRQOL. This study aims to establish an evidence-based age threshold at the time of RC with ONB, beyond which a significant deterioration in HRQOL is observed. We retrospectively analyzed all bladder cancer patients in our department between 2013 and 2022 that fulfilled the EORTC-QLQ-C30 questionnaire preoperatively, as well as at 3 and 12 months after RC with ONB. Patients receiving neoadjuvant or adjuvant chemotherapy or benign/palliative RC were excluded. Overall, 120 patients (81% males) with a mean age of 66 ± 9.6 years underwent RC with ONB and fulfilled the selection criteria. The Global Health Status (GHS) of the EORTC-QLQ-C30 was 64 ± 23 preoperatively, was 64 ± 20 three months postoperatively, and was 68 ± 23 twelve months postoperatively. Overall, 80 (67%) patients presented an increase in GHS at twelve months compared to their preoperative values. The perioperative complications did not differ between patients with decreased and increased GHS. Patients with increased GHS had values of 58 ± 24 preoperatively, 67 ± 19 at 3 months, and 77 ± 16 at 12 months. Patients with decreased GHS had values of 76 ± 16 preoperatively, 57 ± 21 at 3 months, and 50 ± 25 at 12 months. Using ROC analyses with Youden's index, we defined a threshold of 70 years, after which RC with ONB may lead to worse GHS twelve months postoperatively. Worse continence outcomes were the only perioperative and long-term parameters that predicted worse HRQOL in elderly patients. Based on HRQOL, we suggest that RC with an ileal conduit as a urinary diversion should be recommended in patients older than 70 years.
根治性膀胱切除术（RC）并构建回肠原位新膀胱（ONB）可能会对长期健康相关生活质量（HRQOL）产生不利影响。构建ONB时的高龄可能会进一步加剧HRQOL的下降。本研究旨在确定RC并构建ONB时基于证据的年龄阈值，超过该阈值会观察到HRQOL显著恶化。我们回顾性分析了2013年至2022年间在我科接受手术的所有膀胱癌患者，这些患者在术前以及RC并构建ONB后3个月和12个月均完成了欧洲癌症研究与治疗组织生活质量核心问卷（EORTC-QLQ-C30）。接受新辅助或辅助化疗或良性/姑息性RC的患者被排除。总体而言，120例患者（81%为男性）平均年龄66±9.6岁，接受了RC并构建ONB，且符合入选标准。EORTC-QLQ-C30的全球健康状况（GHS）术前为64±23，术后3个月为64±20，术后12个月为68±23。总体而言，80例（67%）患者术后12个月的GHS较术前有所升高。GHS降低和升高的患者围手术期并发症无差异。GHS升高的患者术前值为58±24，3个月时为67±19，12个月时为77±16。GHS降低的患者术前值为76±16，3个月时为57±21，12个月时为50±25。通过使用带有约登指数的ROC分析，我们确定了70岁的阈值，超过该阈值后，RC并构建ONB可能会导致术后12个月的GHS更差。较差的控尿结果是预测老年患者HRQOL更差的唯一围手术期和长期参数。基于HRQOL，我们建议对于70岁以上的患者，应推荐采用回肠导管进行尿流改道的RC。
