Ku Jennifer, Krahn Murray, Trachtenberg John, Nesbitt Michael, Kalnin Robin, Lockwood Gina, Alibhai Shabbir M H
University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA).
Can Urol Assoc J. 2009 Dec;3(6):445-52. doi: 10.5489/cuaj.1171.
Although radical prostatectomy (RP) is an effective treatment for prostate cancer, it has potentially deleterious effects on health-related quality of life (HRQoL). Utility is an important global measure of HRQoL. This utility is also used in decision-making models and economic evaluations. There are no published prospective data characterizing men's utilities for health outcomes post-RP.
From July 2003 to June 2006, patients undergoing RP at the University Health Network in Toronto, Ontario, Canada, completed the Patient-Oriented Prostate Utility Scale (PORPUS), a disease-specific HRQoL and utility instrument. Men were included if they had clinically localized prostate cancer and had completed HRQoL measures prior to surgery and at least once within 9 to 18 months after the RP. Health-related quality of life was measured prior to surgery and at 4 stages after surgery: 0 to 3 months, 3 to 9 months, 9 to 18 months, and 18 to 30 months. Statistical analyses included pairwise t-tests and multivariable linear regression comparing changes in scores between baseline and the 9- to 18-month range.
Two hundred and thirteen men (mean age 60.9, median Gleason score 7) met the inclusion criteria. At baseline, HRQoL was high (mean PORPUS-P [psychometric] = 83.8). Scores declined sharply by 3 months (65.5, p < 0.001) and improved but did not reach baseline by 9-18 months (75.1, p < 0.001). Utility scores (PORPUS-U[utility]) showed the same pattern: 0.94 at baseline; 0.81 at 3 months (p < 0.001); and 0.88 at 9 to 18 months (p < 0.001). Predictors of HRQoL, including baseline PORPUS score, nerve-sparing surgery and smoking status, decline after RP.
Symptom scores are known to be affected up to 12 months after RP. Our study demonstrates that global health status also declines and remains affected 1 year after surgery.
尽管根治性前列腺切除术（RP）是治疗前列腺癌的有效方法，但它对健康相关生活质量（HRQoL）可能有有害影响。效用是HRQoL的一项重要综合指标。这种效用也用于决策模型和经济评估。目前尚无已发表的前瞻性数据描述男性在RP术后健康结局的效用情况。
2003年7月至2006年6月，在加拿大安大略省多伦多大学健康网络接受RP手术的患者完成了以患者为导向的前列腺效用量表（PORPUS），这是一种针对特定疾病的HRQoL和效用工具。纳入标准为患有临床局限性前列腺癌且在手术前及RP术后9至18个月内至少完成过一次HRQoL测量的男性。在手术前以及术后4个阶段测量健康相关生活质量：0至3个月、3至9个月、9至18个月以及18至30个月。统计分析包括配对t检验和多变量线性回归，比较基线与9至18个月期间得分的变化。
213名男性（平均年龄60.9岁，Gleason评分中位数为7）符合纳入标准。在基线时，HRQoL较高（平均PORPUS - P[心理测量学] = 83.8）。得分在3个月时急剧下降（65.5，p < 0.001），随后有所改善，但在9至18个月时未恢复到基线水平（75.1，p < 0.001）。效用得分（PORPUS - U[效用]）呈现相同模式：基线时为0.94；3个月时为0.81（p < 0.001）；9至18个月时为0.88（p < 0.001）。HRQoL的预测因素，包括基线PORPUS评分、保留神经手术和吸烟状况，在RP术后下降。
已知症状评分在RP术后12个月内都会受到影响。我们的研究表明，整体健康状况在术后也会下降，且在术后1年仍受影响。
