一项评估术前激素治疗对控尿恢复效果的回顾性研究。
A retrospective study to evaluate the effect of preoperative hormonal therapy on continence recovery.
作者信息
Wang Yuwen, Zhang Shun, Huang Haifeng, Qiu Xuefeng, Fu Yao, Lyu Xiaoyu, Xu Linfeng, Zhuang Junlong, Guo Hongqian
机构信息
Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Medical School of Southeast University Nanjing Drum Tower Hospital, Nanjing, China.
出版信息
Front Oncol. 2023 Jan 13;12:1059410. doi: 10.3389/fonc.2022.1059410. eCollection 2022.
OBJECTIVE
To evaluate whether different preoperative hormonal therapy options affect postoperative continence and to identify risk/protective factors for continence recovery.
METHODS
This is a retrospective analysis of several clinical trials (NCT04356430, NCT04869371, NCT04992026 and NCT05406999). Data from patients treated with hormonal therapy followed by RARP were collected and analyzed. Continence was defined as 0 pad/day or one safety pad.
RESULTS
The study included 230 patients with adequate information. The median time to continence recovery is 8 weeks. A total of 216 (93.9%) participants recovered to urinary continence within 12 months after surgery. 21 (9.1%) participants achieved immediate continence. 69, 85, 27 and 14 participants restored continence at 1 month, 1-3 month, 3-6 month, 6-12 month, accounting for 30.0%, 40.0%, 11.7% and 6.1% accordingly. No difference in continence recovery was found among different preoperative hormonal treatment options (=0.821). Cox regression showed that membranous urethral length (MUL) was the only independent factor influencing urinary continence recovery either in the univariate analysis (OR=1.13, 95%CI: 1.04-1.22, p=0.002) or in the multivariate analysis (OR=1.12, 95%CI: 1.04-1.20, p=0.002). Different preoperative treatment options were not associated with urinary recovery. More advanced preoperative T stage (OR=0.46, 95%CI: 0.24-0.85, p=0.014) delayed the recovery of immediate continence. MUL was associated with continence restoring at 1 month (OR=1.20, 95%CI: 1.03-1.39, p=0.017), 3 month (OR=1.27, 95%CI: 1.07-1.51, p=0.006), 6 month (OR=1.34, 95%CI: 1.07-1.67, p=0.011) and 12 month (OR=1.36, 95%CI: 1.01-1.84, p=0.044).
CONCLUSION
There is no difference in postoperative continence recovery among ADT, ADT+Docetaxel and ADT+Abiraterone preoperative treatment options. More advanced T stage indicated poor immediate continence recovery. Longer membranous urethral length was a promotional factor for both short-time and long-time continence recovery.
目的
评估不同的术前激素治疗方案是否会影响术后控尿情况，并确定控尿恢复的风险/保护因素。
方法
这是一项对多项临床试验（NCT04356430、NCT04869371、NCT04992026和NCT05406999）的回顾性分析。收集并分析接受激素治疗后行机器人辅助根治性前列腺切除术（RARP）患者的数据。控尿定义为每天使用0片尿垫或1片安全尿垫。
结果
该研究纳入了230例信息充分的患者。控尿恢复的中位时间为8周。共有216例（93.9%）参与者在术后12个月内恢复至尿控。21例（9.1%）参与者实现了即刻控尿。69例、85例、27例和14例参与者分别在1个月、1 - 3个月、3 - 6个月、6 - 12个月恢复控尿，分别占30.0%、40.0%、11.7%和6.1%。不同的术前激素治疗方案在控尿恢复方面未发现差异（P = 0.821）。Cox回归分析显示，在单因素分析（OR = 1.13，95%CI：1.04 - 并确定控尿恢复的风险/保护因素。
方法
这是一项对多项临床试验（NCT04356430、NCT04869371、NCT04992026和NCT05406999）的回顾性分析。收集并分析接受激素治疗后行机器人辅助根治性前列腺切除术（RARP）患者的数据。控尿定义为每天使用0片尿垫或1片安全尿垫。
结果
该研究纳入了230例信息充分的患者。控尿恢复的中位时间为8周。共有216例（93.9%）参与者在术后12个月内恢复至尿控。21例（9.1%）参与者实现了即刻控尿。69例、85例、27例和14例参与者分别在1个月、1 - 3个月、3 - 6个月、6 - 12个月恢复控尿，分别占30.0%、40.0%、11.7%和6.1%。不同的术前激素治疗方案在控尿恢复方面未发现差异（P = 0.821）。Cox回归分析显示，在单因素分析（OR = 1.13，95%CI：1.04 - 1.22，P = 0.002）和多因素分析（OR = 1.12，95%CI：1.04 - 1.20，P = 0.002）中，膜性尿道长度（MUL）是影响尿控恢复的唯一独立因素。不同的术前治疗方案与尿控恢复无关。术前T分期越晚（OR = 0.46，95%CI：0.24 - 0.85，P = 0.014），即刻控尿恢复延迟。MUL与1个月（OR = 1.20，95%CI：1.03 - 1.39，P = 0.017）、3个月（OR = 1.27，95%CI：1.07 - 1.51，P = 0.006）、6个月（OR = 1.34，95%CI：1.07 - 1.67，P = 0.011）和12个月（OR = 1.36，95%CI：1.01 - 1.84，P = 0.044）的控尿恢复相关。
结论
去势治疗（ADT）、ADT + 多西他赛和ADT + 阿比特龙术前治疗方案在术后控尿恢复方面无差异。术前T分期越晚，即刻控尿恢复越差。较长的膜性尿道长度是短期和长期控尿恢复的促进因素。
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