Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.
Department of Radiation Oncology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.
J Urol. 2021 Nov;206(5):1192-1203. doi: 10.1097/JU.0000000000001930. Epub 2021 Jun 29.
The optimal timing of radiotherapy (RT) after radical prostatectomy (RP) remains controversial with unknown impact on health-related quality of life (HRQOL). We aimed to compare the influence of early RT (eRT) and deferred RT (dRT) on HRQOL.
A total of 4,511 patients were analyzed. Inclusion criteria encompassed: ≥pT3, International Society of Urological Pathology grade ≥4, or positive surgical margin. A 1:4 propensity score-matched-analysis of 1,599 patients was conducted (307: eRT, ≤6 months after RP; 1,292: dRT, >6 months after RP). Primary end point was general HRQOL (based on European Organisation for Research and Treatment of Cancer QLQ-C30). Pearson correlation and binary logistic regression models were used to estimate the impact of timing of RT on HRQOL. Functional outcome was assessed using the International Consultation on Incontinence Questionnaire, short form (ICIQ-SF) and International Index of Erectile Function (IIEF-5) questionnaires.
Median followup was 38 months. At 12 months and 24 months followup, general HRQOL scores were significantly higher for dRT (52.7 vs 35.5; p=0.001; 45.8 vs 37.3; p=0.026). ICIQ-SF scores were higher (8.5 vs 6.1; p=0.001; 8.4 vs 7.3; p=0.038), and IIEF-5 scores were lower (1.8 vs 4.2; p=0.001; 2.2 vs 4.4; p=0.005) for eRT at 12 months and 24 months. On multivariate-analysis, dRT was associated with superior general HRQOL at 12 months (OR 0.59, 95% CI 0.37-0.94, p=0.027) and 24 months (OR 0.64, 95% CI 0.39-0.99, p=0.043), respectively. A longer time interval between RP and RT was associated with improved general HRQOL (OR 1.09, 95% CI 1.038-1.143; p <0.001).
dRT yields improved short-term HRQOL compared to eRT. Since longer time intervals between RP and RT predict better short-term HRQOL, our data provide further support for the concept of deferred RT at low prostate specific antigen recurrence.
根治性前列腺切除术（RP）后放射治疗（RT）的最佳时机仍存在争议，其对健康相关生活质量（HRQOL）的影响尚不清楚。我们旨在比较早期 RT（eRT）和延迟 RT（dRT）对 HRQOL 的影响。
共分析了 4511 例患者。纳入标准包括：≥pT3、国际泌尿病理学会分级≥4 或阳性手术切缘。对 1599 例患者进行了 1:4 倾向评分匹配分析（307 例：eRT，RP 后≤6 个月；1292 例：dRT，RP 后>6 个月）。主要终点是一般 HRQOL（基于欧洲癌症研究与治疗组织的 EORTC QLQ-C30 量表）。使用 Pearson 相关和二元逻辑回归模型来估计 RT 时机对 HRQOL 的影响。使用国际尿失禁咨询问卷简表（ICIQ-SF）和国际勃起功能指数（IIEF-5）问卷评估功能结局。
中位随访时间为 38 个月。在 12 个月和 24 个月的随访中，dRT 的一般 HRQOL 评分显著更高（52.7 比 35.5；p=0.001；45.8 比 37.3；p=0.026）。ICIQ-SF 评分更高（8.5 比 6.1；p=0.001；8.4 比 7.3；p=0.038），IIEF-5 评分更低（1.8 比 4.2；p=0.001；2.2 比 4.4；p=0.005）在 12 个月和 24 个月时，eRT 更适合。多变量分析显示，dRT 与 12 个月时的一般 HRQOL 相关（OR 0.59，95%CI 0.37-0.94，p=0.027）和 24 个月时的一般 HRQOL 相关（OR 0.64，95%CI 0.39-0.99，p=0.043）。RP 和 RT 之间的时间间隔越长，一般 HRQOL 越好（OR 1.09，95%CI 1.038-1.143；p<0.001）。
与 eRT 相比，dRT 可改善短期 HRQOL。由于 RP 和 RT 之间的时间间隔越长，短期 HRQOL 越好，我们的数据进一步支持低前列腺特异性抗原复发时延迟 RT 的概念。
