Long-term functional outcomes after treatment for localized prostate cancer.
Long-term functional outcomes after treatment for localized prostate cancer.
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DOI：
10.1056/nejmoa1209978
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发表时间：
2013-01-31
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影响因子：
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通讯作者：
Penson DF
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作者：
Resnick MJ;Koyama T;Fan KH;Albertsen PC;Goodman M;Hamilton AS;Hoffman RM;Potosky AL;Stanford JL;Stroup AM;Van Horn RL;Penson DF
本分析的目的是比较根治性直肠癌切除术或外照射放射治疗后的长期泌尿、肠道和性功能。前列腺癌结局研究（PCOS）招募了3533名在1994年或1995年被诊断为前列腺癌的男性。目前的队列包括1655名年龄在55岁至74岁之间被诊断为局限性前列腺癌的男性，他们接受了手术（1164名男性）或放疗（491名男性）。在基线和诊断后2年、5年和15年评估功能状态。我们使用多变量倾向评分来比较不同治疗的功能结局。在2年（比值比，6.22; 95%置信区间[CI]，1.92 - 20.29）和5年（比值比，5.10; 95% CI，2.29 - 11.36）时，接受尿道切除术的患者比接受放疗的患者更可能发生尿失禁。然而，在15岁时，尿失禁的几率没有显著的组间差异。同样，尽管接受尿道切除术的患者在2年（比值比，3.46; 95%CI，1.93至6.17）和5年（比值比，1.96; 95%CI，1.05至3.63）时更有可能出现勃起功能障碍，但在15年时未观察到显著的组间差异。接受直肠癌切除术的患者在2年（比值比，0.39; 95%CI，0.22 - 0.68）和5年（比值比，0.47; 95%CI，0.26 - 0.84）时发生肠紧迫的可能性较低，15年时肠紧迫的比值也没有显著的组间差异。在15岁时，在接受乳房切除术或放疗的男性中，没有观察到疾病特异性功能结局的显著相对差异。尽管如此，在15年的随访中，接受局限性前列腺癌治疗的男性通常在所有功能领域都有所下降。（由国家癌症研究所资助。
The purpose of this analysis was to compare long-term urinary, bowel, and sexual function after radical prostatectomy or external-beam radiation therapy. The Prostate Cancer Outcomes Study (PCOS) enrolled 3533 men in whom prostate cancer had been diagnosed in 1994 or 1995. The current cohort comprised 1655 men in whom localized prostate cancer had been diagnosed between the ages of 55 and 74 years and who had undergone either surgery (1164 men) or radiotherapy (491 men). Functional status was assessed at baseline and at 2, 5, and 15 years after diagnosis. We used multivariable propensity scoring to compare functional outcomes according to treatment. Patients undergoing prostatectomy were more likely to have urinary incontinence than were those undergoing radiotherapy at 2 years (odds ratio, 6.22; 95% confidence interval [CI], 1.92 to 20.29) and 5 years (odds ratio, 5.10; 95% CI, 2.29 to 11.36). However, no significant between-group difference in the odds of urinary incontinence was noted at 15 years. Similarly, although patients undergoing prostatectomy were more likely to have erectile dysfunction at 2 years (odds ratio, 3.46; 95% CI, 1.93 to 6.17) and 5 years (odds ratio, 1.96; 95% CI, 1.05 to 3.63), no significant between-group difference was noted at 15 years. Patients undergoing prostatectomy were less likely to have bowel urgency at 2 years (odds ratio, 0.39; 95% CI, 0.22 to 0.68) and 5 years (odds ratio, 0.47; 95% CI, 0.26 to 0.84), again with no significant between-group difference in the odds of bowel urgency at 15 years. At 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy. Nonetheless, men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up. (Funded by the National Cancer Institute.)