Conversely, bladder-preserving treatments, notably trimodal therapy, have emerged as compelling alternatives to surgery. Presently, a dearth of randomized data exists for the comparative evaluation of these diverse approaches. Quality of life comparisons predominantly rely on surgical series, such as orthotopic neobladder versus standard urinary diversion, or broader assessments comparing bladder-preserving versus surgical treatment options holistically.
In the pursuit of a comprehensive comparative analysis encompassing standard urinary diversion, continent diversion, and trimodal therapy, our study undertook a systematic review and meta-analysis, presenting detailed data for each of these distinctive approaches.1 This endeavor was conducted under the auspices of a mentorship program initiated within the European Organisation for Research and Treatment of Cancer Quality of Life Group (EORTC QLG). The primary and secondary authors participated as mentee and mentors, respectively, underscoring the scholarly collaboration that underpinned this work.
Furthermore, our review meticulously collected data using specific quality-of-life assessment tools, including EORTC QLQ C30, BLM-30, SF-36, FACT, and BCI/BIS questionnaires. Following a rigorous screening process, we synthesized findings from 50 studies involving 5632 participants, all of which reported data on quality of life outcomes. The pooled analysis, specifically for EORTC QLQ-C30 and BLM-30 questionnaires, revealed that the neobladder approach conferred a significant advantage solely in the domains of Physical and Emotional Functioning when compared to standard surgery.
Conversely, a discernible trend favoring higher mean reported values after trimodal treatment was observed for Global Health Score, Physical Functioning, and Role Functioning when juxtaposed against both surgical approaches. Consequently, a notable benefit for neobladder, as opposed to standard urinary diversion, was discerned exclusively within specific subdomains of quality of life questionnaires. In contrast, data indicated the superiority of trimodal treatment when compared to both reconstructive scenarios.
In summation, our systematic review and meta-analysis represent a substantial contribution to the existing literature on this critical matter, systematically aggregating data related to specific quality-of-life tools across distinct surgical and bladder-sparing approaches. As such, these findings should be integrated into clinical practice, providing valuable insights to treating clinicians in their decision-making processes concerning localized bladder cancer and fostering improved patient awareness regarding the nuanced advantages and disadvantages associated with diverse treatment modalities.
Written by: Giulio Francolini,1 Arunangshu Ghoshal,2
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy.
- University of Toronto, Canada.
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