Litwin M S, Melmed G Y, Nakazon T
Departments of Urology and Health Services, University of California, Los Angeles, California, USA.
J Urol. 2001 Aug;166(2):587-92.
We investigate the longitudinal recovery of quality of life after radical prostatectomy in men with localized prostate cancer.
We assessed the self-reported health related quality of life in 247 men undergoing radical prostatectomy for prostate cancer. Patients were assessed at baseline before surgery and postoperatively every 3 months for 1 year and then every 6 months for up to 48 months (median 30). We measured general and prostate specific health related quality of life with the RAND 36-Item Health Survey 1.0 SF-36 and University of California, Los Angeles Prostate Cancer Index. The Cox proportional hazards regression model was used to determine whether some patients were more likely than others to have a successful return to baseline functioning after treatment.
In the SF-36 60% of patients reached baseline in all domains by 3 months. By 12 months, greater than 90% of patients reached baseline in all domains. Mean recovery time for these domains was about 4(1/2) months. The recovery of urinary function to baseline was 21% at 3, 56% at 12 and 63% at 30 months, respectively. About 80% of patients recovered to baseline urinary bother. In the urinary domains patients who recovered did so at an average of 7 to 8 months, and there was little additional recovery after 18 months. By 1 year postoperatively, approximately a third of patients reached baseline sexual function and about half recovered to baseline sexual bother. At 2 years postoperatively, sexual function and bother returned to baseline in 40% and 60% of patients, respectively. Mean recovery time was about 11 months for sexual function and about 9 months for sexual bother. There was little additional recovery in the sexual domains after 18 to 24 months. In the bowel domains more than two thirds of patients returned to baseline by 3 months, and greater than 90% recovered by 12 months, with a mean recovery of 4.8 months. Unmarried men were more likely than those married to regain baseline sexual function (p = 0.03) and urinary function (p = 0.07). Patients who were 65 years and older were more likely than those younger to return to baseline sexual bother (p = 0.03). There were trends that showed patients with higher incomes as well as those who were white were more likely to recover baseline scores for urinary function and the physical component summary. Another trend suggested that men with a higher education were less likely to regain urinary function (p = 0.08).
Most quality of life recovery occurs early after radical prostatectomy, except in several domains, including urinary and sexual, which continue to improve even beyond 2 years postoperatively. Patients should be encouraged that recovery may continue for months or years after surgery.
我们研究局限性前列腺癌男性患者根治性前列腺切除术后生活质量的纵向恢复情况。
我们评估了247例接受前列腺癌根治性前列腺切除术男性患者自我报告的健康相关生活质量。患者在手术前基线时进行评估，术后每3个月评估1年，然后每6个月评估直至48个月（中位数30个月）。我们使用兰德36项健康调查1.0版SF - 36和加利福尼亚大学洛杉矶分校前列腺癌指数来测量一般和前列腺特异性健康相关生活质量。使用Cox比例风险回归模型来确定某些患者在治疗后比其他患者更有可能成功恢复到基线功能的情况。
在SF - 36中，60%的患者在3个月时所有领域均恢复到基线水平。到12个月时，超过90%的患者在所有领域均恢复到基线水平。这些领域的平均恢复时间约为4.5个月。尿功能恢复到基线水平的比例在3个月时为21%，12个月时为56%，30个月时为63%。约80%的患者恢复到基线排尿困扰水平。在排尿领域，恢复的患者平均在7至8个月时恢复，18个月后几乎没有进一步恢复。术后1年，约三分之一的患者恢复到基线性功能水平，约一半患者恢复到基线性困扰水平。术后2年，性功能和性困扰分别在40%和60%的患者中恢复到基线水平。性功能的平均恢复时间约为11个月，性困扰约为9个月。18至24个月后，性领域几乎没有进一步恢复。在肠道领域，超过三分之二的患者在3个月时恢复到基线水平，超过90%的患者在12个月时恢复，平均恢复时间为4.8个月。未婚男性比已婚男性更有可能恢复到基线性功能（p = 0.03）和尿功能（p = 0.07）。65岁及以上的患者比年轻患者更有可能恢复到基线性困扰水平（p = 0.03）。有趋势表明，收入较高以及白人患者更有可能恢复尿功能和身体成分总结的基线评分。另一个趋势表明，受教育程度较高的男性恢复尿功能的可能性较小（p = 0.08）。
除了包括排尿和性功能在内的几个领域在术后2年甚至更长时间仍持续改善外，大多数生活质量恢复在根治性前列腺切除术后早期发生。应鼓励患者，术后恢复可能会持续数月或数年。
