Chen Ronald C, Clark Jack A, Talcott James A
Center for Outcomes Research, Massachusetts General Hospital Cancer Center, Massachusetts General Hospital, Boston, MA, USA.
J Clin Oncol. 2009 Aug 20;27(24):3916-22. doi: 10.1200/JCO.2008.18.6486. Epub 2009 Jul 20.
Although it is the most powerful predictor of early prostate cancer treatment-related complications and quality-of-life (QOL) outcomes, most studies do not stratify results by baseline function. Further, reporting functional outcomes as averaged numerical results may obscure informatively disparate courses. Using levels of treatment-related dysfunction, we address these problems and present the final QOL outcomes of our prospective cohort study of patients with early prostate cancer.
We created categories for sexual, bowel, and urinary function, measured using numerical scores of the validated Prostate Cancer Symptom Indices and stratified into "normal," "intermediate" and "poor" levels of function by incorporating patient-reported symptom and distress information. We present QOL outcomes for 409 patients 36 months after radical prostatectomy, external-beam radiation therapy, and brachytherapy.
Different levels of baseline sexual, bowel, and urinary function produced distinctive treatment-related changes from baseline to 36 months. In general, the average scale increases in dysfunction were greatest among patients with normal baseline function, although patients with normal and intermediate baseline function had similar increases in sexual dysfunction. For patients whose baseline urinary obstruction/irritation was poor, both average scale scores and most patients' level of function improved after treatment, particularly after surgery.
The use of functional levels to stratify treatment-related outcomes by pretreatment functional status and to display the proportions of patients with improved, stable, or worsened function after treatment provides information that more specifically conveys the expected impact of treatment to patients choosing among localized prostate cancer treatments.
尽管它是早期前列腺癌治疗相关并发症和生活质量（QOL）结果的最有力预测指标，但大多数研究并未按基线功能对结果进行分层。此外，将功能结果报告为平均数值结果可能会掩盖信息上截然不同的病程。通过使用治疗相关功能障碍的水平，我们解决了这些问题，并展示了我们对早期前列腺癌患者进行的前瞻性队列研究的最终生活质量结果。
我们根据经过验证的前列腺癌症状指数的数值评分，为性功能、肠道功能和排尿功能创建了类别，并通过纳入患者报告的症状和痛苦信息，将其分为“正常”、“中等”和“较差”功能水平。我们展示了409例患者在接受根治性前列腺切除术、外照射放疗和近距离放疗36个月后的生活质量结果。
从基线到36个月，不同水平的基线性功能、肠道功能和排尿功能产生了与治疗相关的独特变化。一般来说，基线功能正常的患者功能障碍的平均量表增加幅度最大，尽管基线功能正常和中等的患者性功能障碍的增加幅度相似。对于基线尿路梗阻/刺激较差的患者，治疗后平均量表评分和大多数患者的功能水平均有所改善，尤其是在手术后。
使用功能水平按治疗前功能状态对治疗相关结果进行分层，并展示治疗后功能改善、稳定或恶化的患者比例，提供了更具体地向在局部前列腺癌治疗中进行选择的患者传达治疗预期影响的信息。
