How Does Recurrence of Muscle-Invasive Urothelial Carcinoma Following Radical Surgery Impact HRQoL?

The risk of disease recurrence is high among patients with muscle-invasive urothelial carcinoma (MIUC) following radical surgery, but it’s unclear how recurrence affects health-related quality of life (HRQoL). According to a study presented during the 2021 ASCO Annual Meeting, recurrence has a significant, negative impact on HRQoL, notably among patients who experience distant recurrence.

Patients who underwent radical surgery for high-risk MIUC within the last 120 days randomly received nivolumab 240 mg once every two weeks or placebo for up to one year. During treatment, the EORTC QLQ-C30 and EQ-5D-3L were used every five to six weeks to evaluate HRQoL, then again 35 and 115 days after the last dose, and every three months thereafter until study end (EQ-5D-3L only). The researchers defined confirmed deterioration in HRQoL as “worsening exceeding an a priori points threshold (± 10 for the EORTC QLQ-C30 domains, –7 for the EQ-5D visual analogue scale [VAS]) at ≥ 2 consecutive visits.”

Of 645 patients included for EORTC QLQ-C30, 71 (11%) had local recurrence only and 136 (21%) had distant recurrence. There were 648 patients with EQ-5D-3L. A significant association was observed between recurrence and confirmed deterioration in all HRQoL domains, but across all domains, hazard ratios were higher for patients with distant recurrence than local recurrence.

“Recurrence, particularly distant recurrence, had a significant, negative impact on HRQoL. This suggests that treatment delaying recurrence after radical surgery for high-risk MIUC may prevent or delay HRQoL deterioration in these patients,” the study authors wrote in their conclusion.