基于扩展前列腺癌指数综合评分的健康相关生活质量结局在局限性前列腺癌机器人辅助根治性前列腺切除术后的临床应用
Clinical use of expanded prostate cancer index composite-based health-related quality of life outcomes after robot-assisted radical prostatectomy for localized prostate cancer.
作者信息
Fukuda Kazuhiro, Muto Satoru, China Toshiyuki, Koyasu Hiroki, Noma Yasuhiro, Ashizawa Takeshi, Hirano Hisashi, Kitamura Kosuke, Shimizu Fumitaka, Nagata Masayoshi, Isotani Shuji, Horie Shigeo
机构信息
Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan.
Department of Advanced Informatics for Genetic Disease, Juntendo University, Graduate School of Medicine, Tokyo, Japan.
出版信息
Prostate Int. 2022 Mar;10(1):62-67. doi: 10.1016/j.prnil.2021.08.001. Epub 2021 Sep 4.
BACKGROUND
This study aimed to assess the longitudinal health-related quality of life (HRQOL) using the Expanded Prostate Cancer Index Composite (EPIC) and HRQOL change between the nerve-sparing technique in Japanese men treated with robot-assisted radical prostatectomy (RARP).
METHODS
A total of 573 patients who received RARP were included in this study. EPIC questionnaire was administered before treatment and up to 36 months after RARP. Clinical recovery was defined as half of the standard deviation of the baseline score for each domain. We divided all patients into recovery group or nonrecovery group. The time from survey to each domain recovery was calculated using the Kaplan-Meier method. We compared the sexual and urinary score change between groups using analysis of variance to confirm the effect of nerve-sparing technique.
RESULTS
The median age was 67 years (interquartile range, 62-71 years). The mean score of all urinary domains worsened noticeably after 1 month. All postoperative urinary summary, function, and incontinence scores were significantly lower than preoperative scores up to 3 years post-RARP. Postoperative sexual summary and functional scores were significantly lower than preoperative score at all follow-up times throughout the 36 months. The recovery rate for the urinary incontinence domain was the lowest (44.5%), whereas the recovery rate for the urinary irritative-obstructive domain was the highest (73.7%). In the sexual domain, the bother domain had a higher recovery rate (73.0%) than the functional domain (29.7%). Although the recovery of sexual domains was slower compared with other domains, by 36 months after RARP, almost all values had recovered. Compared with other technique groups, bilateral intrafascial nerve-sparing group showed significantly decreased change in subscale scores before and after RARP in several sexual and urinary domain.
CONCLUSION
The time course and extent of functional and bother domain recovery documented in this study may prove useful for RARP patient selection in Japan.
背景
本研究旨在使用扩展前列腺癌指数综合量表（EPIC）评估日本接受机器人辅助根治性前列腺切除术（RARP）的男性患者在保留神经技术下与健康相关的生活质量（HRQOL）的纵向变化。
方法
本研究共纳入573例接受RARP的患者。在治疗前及RARP术后长达36个月时进行EPIC问卷调查。临床恢复定义为每个领域基线评分标准差的一半。我们将所有患者分为恢复组或未恢复组。使用Kaplan-Meier方法计算从调查到每个领域恢复的时间。我们使用方差分析比较组间的性功能和尿功能评分变化，以确认保留神经技术的效果。
结果
中位年龄为67岁（四分位间距，62 - 71岁）。术后1个月时，所有尿功能领域的平均评分均显著恶化。在RARP术后3年内，所有术后尿功能综合评分、功能评分和尿失禁评分均显著低于术前评分。在整个36个月的所有随访时间点，术后性功能综合评分和功能评分均显著低于术前评分。尿失禁领域的恢复率最低（44.5%），而尿急-梗阻性尿功能领域的恢复率最高（73.7%）。在性功能领域，困扰领域的恢复率（73.0%）高于功能领域（29.7%）。尽管性功能领域的恢复比其他领域慢，但在RARP术后36个月时，几乎所有指标都已恢复。与其他技术组相比，双侧筋膜内保留神经组在几个性功能和尿功能领域的RARP术前和术后分量表评分变化显著降低。
结论
本研究记录的功能和困扰领域恢复的时间进程和程度可能对日本RARP患者的选择有用。
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