Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer.
Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer.
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DOI：
10.1007/s00345-020-03301-0
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发表时间：
2021-04
影响因子：
3.4
通讯作者：
von Hardenberg J
中科院分区：
文献类型：
--
作者：
Westhoff N;Ernst R;Kowalewski KF;Schmidt L;Worst TS;Michel MS;von Hardenberg J
在针对局部前列腺癌（PCa）治疗的选定患者的前瞻性研究中研究了局灶性治疗（FT）。其益处是保留泌尿生殖系统功能和减少并发症，但随访是复杂的，并且与不确定性相关，因为与标准根治性治疗相比，无癌生存率似乎较低。本研究的目的是分析患者报告的接受FT和评估与治疗决定后悔相关的因素。在2014年至2019年的两项前瞻性试验中，52名接受局灶性高强度聚焦超声治疗低至中危PCa的患者有资格接受关于PCa相关治疗遗憾和生活质量的调查（克拉克量表）和以下潜在预测因素：社会人口统计学变量、Charlson Comorbid指数、主观老化（AARC-10 SF）和一般健康相关生活质量（SF-12）。本研究还纳入了癌症持续/复发（12个月后的多参数MRI和融合活检）和功能结局（EPIC-26 UI/UIO/S）数据。总体调查应答率为92.3%（48/52例患者）。中位随访时间为38个月（四分位距= 25-50个月）。共有10例患者（20.8%）报告了治疗决定后悔。在单变量分析中，有临床意义的尿失禁增加显示与后悔显著相关（OR 4.43; 95%CI 0.99-20.53; p = 0.049）。癌症复发（OR 12.31; 95%CI 1.78-159.26; p = 0.023）和克拉克量表中的一般健康担忧（OR 1.07; 95%CI 1.03-1.14; p < 0.01）是多变量logistic回归模型（AUC = 0.892）中后悔的预测因子。FT的可接受性与标准治疗相当。包括定期PSA检测在内的广泛随访不会导致额外的遗憾，但在FT前仔细选择患者和提供信息至关重要。本文的在线版本（10.1007/s 00345 -020-03301-0）包含补充材料，可供授权用户使用。
Focal therapies (FTs) are investigated within prospective studies on selected patients treated for localized prostate cancer (PCa). Benefits are preservation of genitourinary function and reduced complications, but follow-up is elaborate and is associated with uncertainty as cancer-free survival appears to be lower compared to standard radical treatments. The aim of this study was to analyse patient-reported acceptance of FT and evaluate factors associated with treatment decision regret. 52 patients who received focal high-intensity focused ultrasound for low- to intermediate-risk PCa between 2014 and 2019 within two prospective trials were eligible for a survey regarding PCa-related treatment regret and quality-of-life (Clark’s scale) and the following potential predictors: sociodemographic variables, Charlson Comorbidity Index, subjective aging (AARC-10 SF), and general health-related quality-of-life (SF-12). Cancer persistence/recurrence (multiparametric MRI and fusion biopsy after 12 months) and functional outcomes (EPIC-26 UI/UIO/S) data were also included in this study. The overall survey response rate was 92.3% (48/52 patients). Median follow-up was 38 months (interquartile range = 25–50 months). In total, ten patients (20.8%) reported treatment decision regret. In univariable analyses, a clinically meaningful increase in urinary incontinence showed a significant association (OR 4.43; 95% CI 0.99–20.53; p = 0.049) with regret. Cancer recurrence (OR 12.31; 95% CI 1.78–159.26; p = 0.023) and general health worry as a domain of Clark’s scale (OR 1.07; 95% CI 1.03–1.14; p < 0.01) were predictors of regret in a multivariable logistic regression model (AUC = 0.892). Acceptance of FT is comparable to standard treatments. Extensive follow-up including regular PSA testing does not cause additional regret but careful patient selection and information before FT is crucial. The online version of this article (10.1007/s00345-020-03301-0) contains supplementary material, which is available to authorized users.
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影响因子：
45.3
作者：
Clark, JA;Inui, TS;Talcott, JA
通讯作者：
Talcott, JA
DOI：
10.1093/geronb/58.2.s101
发表时间：
2003-03-01
影响因子：
6.2
作者：
Barrett, AE
通讯作者：
Barrett, AE
影响因子：
2.6
作者：
Lin, Yu-Hua
通讯作者：
Lin, Yu-Hua
影响因子：
3.6
作者：
Brehaut, JC;O'Connor, AM;Feldman-Stewart, D
通讯作者：
Feldman-Stewart, D
影响因子：
8.2
作者：
van Stam, Marie-Anne;Aaronson, Neil K.;van der Poel, Henk G.
通讯作者：
van der Poel, Henk G.