一项关于接受主动监测或放射治疗的低风险前列腺癌患者健康相关生活质量结局的前瞻性研究。 - Suppr | 超能文献

Abstract

INTRODUCTION

Patients with low-risk prostate cancer (PCa) often have excellent oncologic outcomes. However, treatment with curative intent can lead to decrements in health-related quality of life (HRQoL). Patients treated with radical prostatectomy have been shown to suffer declines in urinary and sexual HRQoL as compared to those managed with active surveillance (AS). Similarly, patients treated with external-beam radiation therapy (EBRT) are hypothesized to experience greater declines in bowel HRQoL. As health-related quality-of-life (HRQoL) concerns are paramount when selecting among treatment options for low-risk PCa, this study examined HRQoL outcomes in men undergoing EBRT as compared to AS in a prospective, racially diverse cohort.

METHODS

A prospective study of HRQoL in patients with PCa enrolled in the Center for Prostate Disease Research (CPDR) Multicenter National Database was initiated in 2007. The current study included patients diagnosed through April 2014. HRQoL was assessed with the Expanded Prostate Cancer Index Composite (EPIC) and the Medical Outcomes Study Short Form (SF-36). Temporal changes in HRQoL were compared for patients with low-risk PCa managed on AS vs. EBRT at baseline, 1-, 2-, and 3 years post-PCa diagnosis. Longitudinal patterns were modeled using linear regression models fitted with generalized estimating equations (GEE), adjusting for baseline HRQoL, demographic, and clinical patient characteristics.

RESULTS

Of the 499 eligible patients with low-risk PCa, 103 (21%) selected AS and 60 (12%) were treated with EBRT. Demographic characteristics of the treatment groups were similar, though a greater proportion of patients in the EBRT group were African American (P = 0.0003). At baseline, both treatment groups reported comparable HRQoL. EBRT patients experienced significantly worse bowel function and bother at 1 year (adjusted mean score: 87 vs. 95, P = 0.001 and 89 vs. 95, P = 0.008, respectively) and 2 years (87 vs. 93, P = 0.007 and 87 vs. 96, P = 0.002, respectively) compared to patients managed on AS. In contrast to those on AS, more than half the number of patients who received EBRT experienced a decline in bowel function (52% vs. 17%, p=0.003) and bother (52% vs. 15%, P = 0.002) from baseline to 1 year. Patients who received EBRT were significantly more likely to experience a decrease in more than one functional domain (urinary, sexual, bowel, or hormonal) at 1 year when compared with those on AS (60% vs. 28%, P = 0.004).

CONCLUSIONS

Patients receiving EBRT for low-risk prostate cancer suffer declines in bowel HRQoL. These declines are not experienced by patients on AS, suggesting that management of low-risk prostate cancer with AS may offer a means for preserving HRQoL following prostate cancer diagnosis.

摘要

引言

低风险前列腺癌（PCa）患者通常具有良好的肿瘤学预后。然而，根治性治疗可能会导致健康相关生活质量（HRQoL）下降。与接受主动监测（AS）的患者相比，接受根治性前列腺切除术的患者在泌尿和性功能方面的HRQoL有所下降。同样，据推测，接受外照射放疗（EBRT）的患者在肠道HRQoL方面下降幅度更大。由于在为低风险PCa选择治疗方案时，健康相关生活质量（HRQoL）问题至关重要，本研究在一个前瞻性、种族多样的队列中，比较了接受EBRT与接受AS的男性的HRQoL结局。

方法

2007年启动了一项对纳入前列腺疾病研究中心（CPDR）多中心国家数据库的PCa患者的HRQoL进行的前瞻性研究。本研究纳入了截至2014年4月诊断的患者。使用扩展前列腺癌指数综合量表（EPIC）和医学结局研究简表（SF-36）评估HRQoL。比较了低风险PCa患者在基线、PCa诊断后1年、2年和3年时接受AS与EBRT治疗的HRQoL的时间变化。使用拟合广义估计方程（GEE）的线性回归模型对纵向模式进行建模，并对基线HRQoL、人口统计学和临床患者特征进行调整。

结果

在499例符合条件的低风险PCa患者中，103例（21%）选择了AS，60例（12%）接受了EBRT。治疗组的人口统计学特征相似，尽管EBRT组中非洲裔美国人的比例更高（P = 0.0003）。在基线时，两个治疗组报告的HRQoL相当。与接受AS治疗的患者相比，接受EBRT的患者在1年时（调整后平均得分：分别为87对95，P = 0.001和89对95，P = 0.008）和2年时（87对93，P = 0.007和87对96，P = 0.002）肠道功能和困扰明显更差。与接受AS治疗的患者相比，接受EBRT治疗的患者从基线到1年肠道功能下降（52%对17%，p = 0.003）和困扰下降（52%对15%，P = 0.002）的人数超过一半。与接受AS治疗的患者相比，接受EBRT治疗的患者在1年时在多个功能领域（泌尿、性、肠道或激素）出现下降的可能性显著更高（60%对28%，P = 0.004）。

结论

接受EBRT治疗的低风险前列腺癌患者肠道HRQoL下降。接受AS治疗的患者未出现这些下降，这表明采用AS管理低风险前列腺癌可能为前列腺癌诊断后维持HRQoL提供一种方法。