Litwin M S, Hays R D, Fink A, Ganz P A, Leake B, Leach G E, Brook R H
Division of Urology, UCLA School of Medicine 90024-1738.
JAMA. 1995 Jan 11;273(2):129-35. doi: 10.1001/jama.273.2.129.
To assess health-related quality of life (HRQOL) in men treated for clinically localized prostate cancer.
A cross-sectional analysis of HRQOL after treatment with radical prostatectomy, pelvic irradiation, or observation alone for clinically localized prostatic adenocarcinoma, and in age-matched comparison patients.
A large managed care population in California.
A total of 528 men, including 214 treated for clinically localized prostate cancer (41 with evidence of metastatic disease were excluded from this analysis) and 273 age-matched, ZIP code-matched comparison patients without prostate cancer. Cancer patients were analyzed in three treatment groups: radical prostatectomy (n = 98), primary pelvic irradiation (n = 56), and observation alone (n = 60).
General HRQOL was measured with the RAND 36-Item Health Survey 1.0. Cancer-specific HRQOL was measured with the CAncer Rehabilitation Evaluation System-Short Form and the Functional Assessment of Cancer Therapy-General form. Disease-targeted quality of life was measured with a new instrument assessing function and bother in three organ systems: sexual, urinary, and bowel.
No differences among treatment groups were seen in comparisons of general HRQOL: Significant differences among treatment groups were seen in both function and bother in the prostate-targeted measures of sexual, urinary, and bowel domains. When cancer patients were compared with men of similar age without prostate cancer, differences were seen in the sexual, urinary, and bowel function and bother but not in general HRQOL measures. Although cancer-free men were found not to have full potency or continence, prostate cancer patients treated with surgery or radiation reported significantly worse sexual, urinary, and bowel function than men without cancer. Men who had undergone nerve-sparing prostatectomy did not differ from those who had undergone standard prostatectomy, but the power to detect a difference was low.
Although no differences were seen in general HRQOL, three disease-targeted domains were found to differ significantly among the treatment groups and comparison patients. Even after controlling for the sexual and urinary dysfunction experienced by older men without cancer, those receiving therapeutic interventions for their prostate cancer were found to have poorer disease-targeted HRQOL: We conclude that in addition to general HRQOL, disease-targeted measures must be used to assess outcomes of care in men treated for localized prostate cancer.
评估接受临床局限性前列腺癌治疗的男性的健康相关生活质量（HRQOL）。
对接受根治性前列腺切除术、盆腔放疗或仅观察治疗的临床局限性前列腺腺癌患者以及年龄匹配的对照患者治疗后的HRQOL进行横断面分析。
加利福尼亚州一个大型管理式医疗人群。
共528名男性，其中214名接受临床局限性前列腺癌治疗（41名有转移疾病证据的患者被排除在本分析之外），273名年龄匹配、邮政编码匹配的无前列腺癌对照患者。癌症患者分为三个治疗组：根治性前列腺切除术（n = 98）、原发性盆腔放疗（n = 56）和仅观察（n = 60）。
用兰德36项健康调查1.0测量一般HRQOL。用癌症康复评估系统简表和癌症治疗功能评估通用表测量癌症特异性HRQOL。用一种新的工具测量针对疾病的生活质量，该工具评估三个器官系统（性、泌尿和肠道）的功能和困扰。
在一般HRQOL比较中，各治疗组之间未见差异；在针对前列腺的性、泌尿和肠道领域的功能和困扰测量中，各治疗组之间存在显著差异。当癌症患者与年龄相仿的无前列腺癌男性进行比较时，在性、泌尿和肠道功能及困扰方面存在差异，但在一般HRQOL测量中无差异。尽管发现无癌男性没有完全的性功能或控尿能力，但接受手术或放疗的前列腺癌患者报告的性、泌尿和肠道功能明显比无癌男性差。接受保留神经前列腺切除术的男性与接受标准前列腺切除术的男性没有差异，但检测差异的效能较低。
尽管在一般HRQOL方面未见差异，但发现三个针对疾病的领域在治疗组和对照患者之间存在显著差异。即使在控制了无癌老年男性经历的性功能和排尿功能障碍后，接受前列腺癌治疗干预的患者的针对疾病的HRQOL仍较差。我们得出结论，除了一般HRQOL外，还必须使用针对疾病的测量方法来评估接受局限性前列腺癌治疗的男性的护理结果。
