Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Acta Oncol. 2023 Nov;62(11):1440-1450. doi: 10.1080/0284186X.2023.2259597. Epub 2023 Nov 7.
To evaluate the persistence of symptoms after radiotherapy (RT) for localised prostate cancer (PCa) and the association with quality of life (QOL).
Prospective patient-reported outcome (PRO) from a multi-institutional study on PCa treated with radical RT (2010-2014) was analysed. Data was collected at baseline (BL) and follow-ups (FUPs) up to 5 years. Patients with BL and ≥3 late FUPs (≥6 months) were analysed. PRO was scored by means of the IPSS and ICIQ-SF (urinary), LENT-SOMA (gastrointestinal [GI]), and EORTC-C30 (pain, insomnia, fatigue, and QOL) questionnaires. Symptoms were defined 'persistent' if the median score over FUPs was ≥3 (urinary) or ≥2 (GI, pain, insomnia, and fatigue), and worse than BL. Different thresholds were chosen to have enough events for each symptom. QOL was linearly transformed on a continuous scale (0-100). Linear-mixed models were used to identify significant differences between groups with and without persistent symptoms including age, smoking status, previous abdominal surgery, and diabetes as confounders. Mean QOL differences between groups were evaluated longitudinally over FUPs.
The analysis included 293 patients. Persistent urinary symptoms ranged from 2% (straining) to 12% (weak stream, and nocturia). Gastrointestinal symptoms ranged from 7% (rectal pain, and incontinence) to 30% (urgency). Proportions of pain, insomnia, and fatigue were 6, 13, and 18%. Significant QOL differences of small-to-medium clinical relevance were found for urinary incontinence, frequency, urgency, and nocturia. Among GI symptoms, rectal pain and incontinence showed small-to-medium differences. Fatigue was associated with the largest differences.
The analysis showed that symptoms after RT for PCa occur with different persistence and their association with QOL varies in magnitude. A number of persistent urinary and GI symptoms showed differences in a comparable range. Urinary incontinence and frequency, rectal pain, and faecal incontinence more often had significant associations. Fatigue was also prevalent and associated with largely deteriorated QOL.
评估局部前列腺癌（PCa）放疗（RT）后症状的持续时间及其与生活质量（QOL）的关系。
对 2010-2014 年接受根治性 RT 治疗的 PCa 多机构研究的前瞻性患者报告结局（PRO）进行分析。在基线（BL）和随访（FUP）中收集数据，随访时间长达 5 年。对 BL 和至少 3 次晚期 FUP（≥6 个月）的患者进行分析。PRO 通过 IPSS 和 ICIQ-SF（尿）、LENT-SOMA（胃肠道[GI]）和 EORTC-C30（疼痛、失眠、疲劳和 QOL）问卷进行评分。如果 FUP 期间的中位数评分≥3（尿）或≥2（GI、疼痛、失眠和疲劳），且比 BL 更差，则定义为“持续”症状。为每个症状选择不同的阈值，以获得足够的事件。QOL 在连续量表（0-100）上进行线性变换。使用线性混合模型来确定有和无持续症状组之间的显著差异，包括年龄、吸烟状况、既往腹部手术和糖尿病作为混杂因素。在 FUP 期间，评估组间 QOL 的纵向差异。
该分析纳入了 293 名患者。持续性尿症状从 2%（费力）到 12%（尿流弱、夜尿）不等。胃肠道症状从 7%（直肠疼痛和失禁）到 30%（尿急）不等。疼痛、失眠和疲劳的比例分别为 6%、13%和 18%。在尿失禁、频率、尿急和夜尿方面，发现了具有中等临床相关性的 QOL 显著差异。在胃肠道症状中，直肠疼痛和失禁存在较小到中等的差异。疲劳与最大差异相关。
分析表明，PCa 放疗后症状的持续时间不同，与 QOL 的关系在程度上也有所不同。一些持续性的尿和胃肠道症状在可比范围内存在差异。尿失禁和频率、直肠疼痛和粪便失禁更常与显著的关联。疲劳也很普遍，并与 QOL 大幅恶化有关。
