Peer Review Report For: QUEST: Quality of Life and Evaluation of Survival in Treatment of Bladder Cancer – A Prospective Study on Quality of Life and Survival of Bladder Cancer Patients Using Patient-Reported Outcome Measurements (PROMs) [version 1; peer review: 1 approved]

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Background Muscle-invasive bladder cancer (MIBC) is a clinically aggressive disease requiring intensive treatment. The two principal curative approaches are radical cystectomy (RC) and bladder preservation therapy, most commonly trimodal therapy (TMT), which combines maximal transurethral resection of the bladder tumor (TURBT) with concurrent chemoradiation. While both strategies have demonstrated comparable oncologic outcomes in select patient populations, their impact on health-related quality of life (QoL) remains a crucial differentiator—particularly in real-world, resource-constrained settings where cultural and logistical considerations shape patient preferences and treatment access. Objectives The QUEST (Quality of life and Evaluation of Survival in Treatment of bladder cancer) study aims to evaluate and compare QoL outcomes and survival metrics in MIBC patients undergoing either RC or bladder preservation. It seeks to generate institution-specific data using validated patient-reported outcome measures (PROMs), thereby supporting individualized, evidence-informed decision-making. Methods This prospective, single-center, observational cohort study will enroll 94 patients with non-metastatic MIBC (cT2–T4aN0M0) who are eligible for either treatment approach. Participants will self-select their treatment modality following multidisciplinary counseling. QoL will be assessed longitudinally using the Bladder Cancer Index (BCI) and EORTC QLQ-C30 at baseline and multiple post-treatment intervals. Secondary endpoints include overall survival (OS), progression-free survival (PFS), and correlation of PROM scores with survival. Stratification and statistical adjustments will address inherent selection bias. Discussion The QUEST study will provide critical insights into the lived experiences and clinical outcomes of MIBC patients in eastern India. By integrating PROMs into routine oncologic evaluation, it will help bridge the gap between survival-centric and patient-centric care models. The findings are expected to inform future guidelines, promote shared decision-making, and enhance long-term care strategies for bladder cancer in similar healthcare settings. Trial Registration : CTRI/2025/03/083504

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