Wei J T, Dunn R L, Litwin M S, Sandler H M, Sanda M G
Veterans Affairs Center for Practice Management and Outcomes Research, Ann Arbor, Michigan, USA.
Urology. 2000 Dec 20;56(6):899-905. doi: 10.1016/s0090-4295(00)00858-x.
Health-related quality of life (HRQOL) is an increasingly important endpoint in prostate cancer care. However, pivotal issues that are not fully assessed in existing HRQOL instruments include irritative urinary symptoms, hormonal symptoms, and multi-item scores quantifying bother between urinary, sexual, bowel, and hormonal domains. We sought to develop a novel instrument to facilitate more comprehensive assessment of prostate cancer-related HRQOL.
Instrument development was based on advice from an expert panel and prostate cancer patients, which led to expanding the 20-item University of California-Los Angeles Prostate Cancer Index (UCLA-PCI) to the 50-item Expanded Prostate Index Composite (EPIC). Summary and subscale scores were derived by content and factor analyses. Reliability and validity were assessed by test-retest correlation, Cronbach's alpha coefficient, interscale correlation, and EPIC correlation with other validated instruments.
Test-retest reliability and internal consistency were high for EPIC urinary, bowel, sexual, and hormonal domain summary scores (each r >/=0.80 and Cronbach's alpha >/=0.82) and for most domain-specific subscales. Correlations between function and bother subscales within domains were high (r >0.60). Correlations between different primary domains were consistently lower, indicating that these domains assess distinct HRQOL components. EPIC domains had weak to modest correlations with the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12), indicating rationale for their concurrent use. Moderate agreement was observed between EPIC domains relevant to the Functional Assessment of Cancer Therapy Prostate module (FACT-P) and the American Urological Association Symptom Index (AUA-SI), providing criterion validity without excessive overlap.
EPIC is a robust prostate cancer HRQOL instrument that complements prior instruments by measuring a broad spectrum of urinary, bowel, sexual, and hormonal symptoms, thereby providing a unique tool for comprehensive assessment of HRQOL issues important in contemporary prostate cancer management.
与健康相关的生活质量（HRQOL）在前列腺癌护理中日益成为一个重要的终点指标。然而，现有HRQOL工具未充分评估的关键问题包括刺激性尿路症状、激素症状以及量化泌尿、性、肠道和激素领域之间困扰程度的多项目评分。我们试图开发一种新型工具，以促进对前列腺癌相关HRQOL进行更全面的评估。
工具开发基于专家小组和前列腺癌患者的建议，这导致将20项的加利福尼亚大学洛杉矶分校前列腺癌指数（UCLA - PCI）扩展为50项的扩展前列腺指数综合量表（EPIC）。通过内容分析和因子分析得出汇总分数和分量表分数。通过重测相关性、克朗巴赫α系数、量表间相关性以及EPIC与其他经过验证的工具的相关性来评估信度和效度。
EPIC泌尿、肠道、性和激素领域汇总分数（每个r≥0.80且克朗巴赫α≥0.82）以及大多数领域特定分量表的重测信度和内部一致性都很高。各领域内功能量表和困扰量表之间的相关性很高（r>0.60）。不同主要领域之间的相关性始终较低，表明这些领域评估的是不同的HRQOL组成部分。EPIC各领域与医学结果研究12项简短健康调查（SF - 12）的相关性较弱至中等，表明它们可同时使用的合理性。在与癌症治疗前列腺模块功能评估（FACT - P）和美国泌尿外科学会症状指数（AUA - SI）相关的EPIC领域之间观察到中等程度的一致性，提供了标准效度且无过度重叠。
EPIC是一种强大的前列腺癌HRQOL工具，通过测量广泛的泌尿、肠道、性和激素症状来补充先前的工具，从而为全面评估当代前列腺癌管理中重要的HRQOL问题提供了一个独特的工具。
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