澳大利亚新南威尔士州癌症委员会Carolyn G Mazariego团队研究了局限性前列腺癌患者随访15年的生活质量结局。2020年10月7日，《英国医学杂志》发表了该成果。
为了评估确诊为局部前列腺癌后长达15年的与治疗相关的生活质量变化，研究组在澳大利亚新南威尔士州进行了一项基于人群的前瞻性队列研究。
研究组招募了1642名70岁以下、患有局限性前列腺癌的男性，以及786名对照者。在15年内的七个时间点自我报告一般健康和特定疾病的生活质量，使用12个项目的简短健康调查量表对生活质量进行评估，并与对照组比较。
随访15年后，所有治疗组均报告高水平的勃起功能障碍，因治疗方法不同发生率从62.3％至83.0％不等，对照组的发生率为42.7%。以外照射治疗、高剂量近距离放射治疗或雄激素剥夺治疗作为主要治疗的男性报告了更多的肠道问题。在接受手术的男性中尿失禁尤为普遍和持续，据报道，接受雄激素剥夺治疗的人群中在10-15年尿失禁持续增加。
研究结果表明，接受局部前列腺癌主动治疗的患者自我报告的长期生活质量显著差于未患前列腺癌的男性。接受根治性前列腺切除术治疗的男性表现得特别糟糕，尤其是在长期性功能方面。
附：英文原文
Title: Fifteen year quality of life outcomes in men with localised prostate cancer: population based Australian prospective study
Author: Carolyn G Mazariego, Sam Egger, Madeleine T King, Ilona Juraskova, Henry Woo, Martin Berry, Bruce K Armstrong, David P Smith
Issue&Volume: 2020/10/07
Abstract:
Objective To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer.
Design Population based, prospective cohort study with follow-up over 15 years.
Setting New South Wales, Australia.
Participants 1642 men with localised prostate cancer, aged less than 70, and 786 controls randomly recruited from the New South Wales electoral roll into the New South Wales Prostate Cancer Care and Outcomes Study (PCOS).
Main outcome measures General health and disease specific quality of life were self-reported at seven time points over a 15 year period, using the 12-item Short Form Health Survey scale, University of California, Los Angeles prostate cancer index, and expanded prostate cancer index composite short form (EPIC-26). Adjusted mean differences were calculated with controls as the comparison group. Clinical significance of adjusted mean differences was assessed by the minimally important difference, defined as one third of the standard deviation (SD) from the baseline score.
Results At 15 years, all treatment groups reported high levels of erectile dysfunction, depending on treatment (62.3% (active surveillance/watchful waiting, n=33/53) to 83.0% (non-nerve sparing radical prostatectomy, n=117/141)) compared with controls (42.7% (n=44/103)). Men who had external beam radiation therapy or high dose rate brachytherapy or androgen deprivation therapy as primary treatment reported more bowel problems. Self-reported urinary incontinence was particularly prevalent and persistent for men who underwent surgery, and an increase in urinary bother was reported in the group receiving androgen deprivation therapy from 10 to 15 years (year 10: adjusted mean difference 5.3, 95% confidence interval 10.8 to 0.2; year 15: 15.9; 25.1 to 6.7).
Conclusions Patients receiving initial active treatment for localised prostate cancer had generally worse long term self-reported quality of life than men without a diagnosis of prostate cancer. Men treated with radical prostatectomy faired especially badly, particularly in relation to long term sexual outcomes. Clinicians and patients should consider these long term quality of life outcomes when making treatment decisions.
DOI: 10.1136/bmj.m3503
Source: https://www.bmj.com/content/371/bmj.m3503
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
官方网址：http://www.bmj.com/
投稿链接：https://mc.manuscriptcentral.com/bmj
本期文章：《英国医学杂志》：Online/在线发表
