Lakomy David S, Yoder Alison K, Wu Juliana, Hernandez Mike, Ayoola-Adeola Martins, Jhingran Anuja, Klopp Ann, Soliman Pamela, Peterson Susan K, Lin Lilie L
Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.
Int J Gynecol Cancer. 2022 Oct 3;32(10):1266-1275. doi: 10.1136/ijgc-2022-003417.
Pelvic floor dysfunction is a common adverse effect of uterine cancer treatment. In this study we compared patient-reported outcomes regarding pelvic floor dysfunction among uterine cancer survivors after hysterectomy and bilateral salpingo-oophorectomy, surgery and brachytherapy, or surgery and external beam radiotherapy with or without brachytherapy versus women who had a hysterectomy for benign indications.
We used the validated 20-item Pelvic Floor Distress Inventory to assess lower urinary distress, colorectal distress, and pelvic organ prolapse dysfunction in each treatment group. Pelvic floor dysfunction-related quality of life in these domains was compared across treatment modalities using the Pelvic Floor Impact Questionnaire-7. Treatment type, body mass index, comorbidities, and number of vaginal births were obtained from medical records. A zero-inflated negative binomial regression model was used to assess the association of treatment regimens and covariates relative to the non-cancer cohort.
A total of 309 surveys were analyzed. The median age of the patients at surgery was 58 years (range 20-87) and the median age at survey completion was 66 years (range 34-92). Most participants reported experiencing at least one symptom of pelvic floor dysfunction (76% by Pelvic Floor Distress Inventory-2). The type of treatment had no effect on overall pelvic floor dysfunction on multivariate analysis (all p>0.05). Worse urinary-related symptoms were associated with higher body mass index at surgery (OR 1.41), higher age at time of survey (OR 1.07), and higher numbers of vaginal births (OR 1.43) (all p<0.05).
Overall, pelvic floor dysfunction did not significantly vary by treatment modality. Our findings suggest complex interactions among age, body mass index, and parity as to how uterine cancer treatment affects pelvic floor quality of life, which should be considered in the choice of treatment strategy and patient counseling.
盆底功能障碍是子宫癌治疗常见的不良反应。在本研究中，我们比较了子宫癌幸存者在子宫切除加双侧输卵管卵巢切除术后、手术加近距离放疗、或手术加外照射放疗（无论是否联合近距离放疗）与因良性指征行子宫切除术的女性患者报告的盆底功能障碍相关结局。
我们使用经过验证的20项盆底困扰量表评估各治疗组的下尿路困扰、结直肠困扰和盆腔器官脱垂功能障碍。使用盆底影响问卷-7比较这些领域中与盆底功能障碍相关的生活质量在不同治疗方式之间的差异。从病历中获取治疗类型、体重指数、合并症和阴道分娩次数。使用零膨胀负二项回归模型评估治疗方案和协变量相对于非癌症队列的关联。
共分析了309份调查问卷。手术时患者的中位年龄为58岁（范围20 - 87岁），调查完成时的中位年龄为66岁（范围34 - 92岁）。大多数参与者报告至少经历过一种盆底功能障碍症状（盆底困扰量表-2显示为76%）。多因素分析显示，治疗类型对总体盆底功能障碍无影响（所有p>0.05）。更严重的泌尿系统相关症状与手术时较高的体重指数（OR 1.41）、调查时较高的年龄（OR 1.07）以及较多的阴道分娩次数（OR 1.43）相关（所有p<0.05）。
总体而言，盆底功能障碍在不同治疗方式之间无显著差异。我们的研究结果表明，在子宫癌治疗对盆底生活质量的影响方面，年龄、体重指数和产次之间存在复杂的相互作用，在选择治疗策略和对患者进行咨询时应予以考虑。
