Hu Jim C, Elkin Eric P, Pasta David J, Lubeck Deborah P, Kattan Michael W, Carroll Peter R, Litwin Mark S
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, 90095, USA.
J Urol. 2004 Feb;171(2 Pt 1):703-7; discussion 707-8. doi: 10.1097/01.ju.0000107964.61300.f6.
We investigated the usefulness of patient and tumor characteristics in predicting continence, potency, and physical and mental health 1 year after radical prostatectomy.
We studied 372 men drawn from Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a national, longitudinal cohort, who underwent radical prostatectomy alone for localized prostate cancer. Health related quality of life (HRQOL) was assessed before and 12 months after (range 9 to 15) surgery with the Physical and Mental Component Summaries of the RAND 36-Item Health Survey and the Sexual and Urinary Function scales of the UCLA Prostate Cancer Index. Covariates included clinical T stage, prostate specific antigen Gleason sum, age, race, income, education, relationship status, comorbidity and overall health self-rating. Chi-square and backward stepwise multivariate analysis identified differences between men who did and did not return to baseline HRQOL postoperatively. Return to baseline HRQOL score was set at 90% or greater for physical and mental health, 80% for continence and 75% for potency.
After 1 year 63%, 20%, 80% and 86% returned to baseline continence, potency, physical health and mental health, respectively. Men younger than 65 years were more likely to return to baseline continence, potency, and physical but not mental health. Univariate analyses also revealed several other characteristics to predict (p <0.05) better outcomes including household income greater than 30,000 US dollars (potency, physical health), fewer comorbidities (potency, physical health), and excellent or very good health self-rating (mental health). In multivariate analyses subjects younger than 65 years were more likely to return to baseline urinary (OR 1.8, p <0.01), sexual (OR 2.5, p <0.01) and physical health (OR 1.8, p = 0.03). Furthermore, subjects with no comorbidities were more likely to return to baseline physical health (OR 2.5, p = 0.01), while those with an excellent or very good baseline health self-rating were more likely to return to baseline mental health (OR 2.3, p = 0.01). Clinical T stage, prostate specific antigen and Gleason sum did not predict return to baseline HRQOL.
Younger patient age (less than 65) is associated with a greater likelihood of returning to baseline continence, potency and physical health after radical prostatectomy. In addition, patients who underwent radical prostatectomy without comorbidities and those with high health self-ratings are more likely to return to baseline physical and mental health, respectively. Preoperative tumor characteristics do not appear to be associated with regaining baseline HRQOL, suggesting that factors not measured in this model may be important in optimizing quality of life after radical prostatectomy.
我们研究了患者及肿瘤特征对于预测根治性前列腺切除术后1年控尿、性功能以及身心健康状况的作用。
我们对372名男性进行了研究，这些男性来自前列腺癌战略泌尿学研究计划（CaPSURE），这是一个全国性的纵向队列，他们仅因局限性前列腺癌接受了根治性前列腺切除术。采用兰德36项健康调查的生理和心理综合评分以及加州大学洛杉矶分校前列腺癌指数的性功能和排尿功能量表，在手术前以及手术后12个月（范围为9至15个月）评估健康相关生活质量（HRQOL）。协变量包括临床T分期、前列腺特异性抗原Gleason评分、年龄、种族、收入、教育程度、婚姻状况、合并症以及总体健康自评。卡方检验和向后逐步多变量分析确定了术后恢复至基线HRQOL的男性与未恢复者之间的差异。将恢复至基线HRQOL评分设定为：生理和心理健康方面为90%或更高，控尿方面为80%，性功能方面为75%。
1年后，分别有63%、20%、80%和86%的患者恢复至基线控尿、性功能、生理健康和心理健康水平。年龄小于65岁的男性更有可能恢复至基线控尿、性功能和生理健康水平，但心理健康方面并非如此。单变量分析还揭示了其他几个可预测（p<0.05）更好结局的特征，包括家庭收入高于30,000美元（性功能、生理健康）、合并症较少（性功能、生理健康）以及健康自评优秀或非常好（心理健康）。在多变量分析中，年龄小于65岁的受试者更有可能恢复至基线排尿功能（OR 1.8，p<0.01）、性功能（OR 2.5，p<0.01）和生理健康水平（OR 1.8，p = 0.03）。此外，无合并症的受试者更有可能恢复至基线生理健康水平（OR 2.5，p = 0.01），而基线健康自评优秀或非常好的受试者更有可能恢复至基线心理健康水平（OR 2.3，p = 0.01）。临床T分期、前列腺特异性抗原和Gleason评分无法预测是否恢复至基线HRQOL。
年龄较轻（小于65岁）的患者在根治性前列腺切除术后更有可能恢复至基线控尿、性功能和生理健康水平。此外，无合并症接受根治性前列腺切除术的患者以及健康自评较高的患者分别更有可能恢复至基线生理和心理健康水平。术前肿瘤特征似乎与恢复至基线HRQOL无关，这表明该模型中未测量的因素可能对优化根治性前列腺切除术后的生活质量很重要。
