To investigate the prognostic significance of preoperative health-related quality of life (HRQOL) functioning scores, assessed by the EORTC QLQ-C30 questionnaire, in predicting survival outcomes for patients undergoing radical cystectomy (RC) for urothelial carcinoma (UC) of the bladder. While established prognostic factors include tumor stage and lymph node involvement, the role of HRQOL in survival remains underexplored.

We retrospectively analyzed patients who underwent RC for bladder cancer at a tertiary center between April 2013 and August 2024. Preoperative HRQOL domains—physical (PF), role (RF), and emotional functioning (EF)—were assessed using the EORTC QLQ-C30 questionnaire. Patients were stratified based on PF scores (≥ 90 vs. <90), and propensity score matching was applied. Survival outcomes, including overall survival (OS) and recurrence-free survival (RFS), were analyzed using Kaplan–Meier estimates and Cox regression models.

Overall, 276 patients were included. Patients with PF scores ≥ 90 had significantly higher 5-year OS (80.4% vs. 55.5%, p = 0.003) and lower recurrence rates. Low PF scores were an independent predictor of worse OS (HR: 2.54, 95% CI 1.42–4.55, p = 0.002). RF scores also influenced OS, while EF scores showed no association with survival.

Preoperative PF and RF scores provide valuable prognostic information for patients undergoing RC. Given the modifiable nature of PF, prehabilitation programs could improve outcomes. Integrating HRQOL assessments into routine preoperative evaluations may enhance personalized risk stratification and patient care.