Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
Urol Oncol. 2023 Oct;41(10):429.e9-429.e14. doi: 10.1016/j.urolonc.2023.06.003. Epub 2023 Jul 3.
To report objective long-term complications and health related quality of life (HRQOL) outcomes after radical prostatectomy (RP) with and without radiation therapy (RT) for prostate cancer (CaP).
We analyzed patients diagnosed with CaP who underwent RP from the UCSF Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry between 1995 and 2020. Cox proportional hazards were used to assess risk of postoperative complications which included cystitis, gastrointestinal (GI) toxicity, incontinence requiring a surgical procedure, ureteral injury and urinary stricture. Repeated measures mixed models were used to assess the effects of radiation and complications on patient-reported urinary, bowel, and sexual function after surgery.
Of 6,258 men who underwent RP, cumulative incidence of EBRT was 9.1% at 5 years after surgery. Patients who received postoperative radiation were at increased risk for onset of cystitis (HR 5.60, 95% CI 3.40-9.22, P < 0.01). Receipt of RT was not associated with other complications. In repeated measures analysis, postoperative RT was associated with worsening general health scores, adjusting for complications of incontinence, urinary stricture, GI toxicity or ureteral injury, independent of whether patients had those complications.
RT after RP was associated with an increase in the risk of cystitis and worse general health in the long term. Other complications and HRQOL outcomes did not demonstrate differences by whether patients had RT or not. While post-operative RT is the only curative option for CaP after RP, patients and providers should be aware of the increased risks when making treatment decisions.
报告根治性前列腺切除术（RP）后伴或不伴放射治疗（RT）治疗前列腺癌（CaP）的客观长期并发症和健康相关生活质量（HRQOL）结局。
我们分析了 1995 年至 2020 年期间 UCSF 前列腺癌战略泌尿科研究努力（CaPSURE）登记处接受 RP 的 CaP 患者。使用 Cox 比例风险评估术后并发症的风险，包括膀胱炎、胃肠道（GI）毒性、需要手术治疗的尿失禁、输尿管损伤和尿狭窄。重复测量混合模型用于评估放射治疗和并发症对术后患者报告的尿、肠和性功能的影响。
在 6258 名接受 RP 的男性中，术后 5 年 EBRT 的累积发生率为 9.1%。接受术后放射治疗的患者发生膀胱炎的风险增加（HR 5.60，95%CI 3.40-9.22，P<0.01）。接受 RT 与其他并发症无关。在重复测量分析中，术后 RT 与一般健康评分恶化相关，调整了尿失禁、尿狭窄、GI 毒性或输尿管损伤的并发症后，与患者是否有这些并发症无关。
RP 后 RT 与膀胱炎风险增加和长期一般健康状况恶化相关。其他并发症和 HRQOL 结局并没有因患者是否接受 RT 而有所不同。虽然术后 RT 是 RP 后 CaP 的唯一治愈选择，但在做出治疗决策时，患者和提供者应意识到风险增加。
