Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer - A predictive model
Adjuvant radiotherapy is associated with increased sexual dysfunction in male patients undergoing resection for rectal cancer - A predictive model
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DOI：
10.1097/01.sla.0000183608.24549.68
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发表时间：
2005-10-01
影响因子：
9
通讯作者：
Lavery, IC
中科院分区：
文献类型：
--
作者：
Heriot, AG;Tekkis, PP;Lavery, IC
目的：本研究的目的是评估放射治疗（RT）对直肠癌肿瘤切除术患者性功能的影响，并建立一个数学模型来量化这组患者性功能障碍的风险。方法：前瞻性收集接受直肠乙状结肠切除术患者的数据第1组：n = 101）或辅助放疗（40-50戈伊）和直肠癌切除术（第2组：n = 100）。在7个时间间隔（术前、术后4个月、8个月、1年、2年、3年和4年）记录研究终点，包括：1）勃起能力，2）维持勃起，3）达到性高潮，4）干性性高潮，5）是否性活跃。多水平Logistic回归分析重复测量，以确定与性功能障碍的相关因素。通过比较观察结果和模型预测结果，建立了一个预测模型，并进行了内部验证。结果：与单纯手术患者相比，放疗对勃起、维持勃起、达到性高潮和性活跃的能力有不良影响术后8个月分别下降7.4%、12.6%、16.2%、13.7%（P < 0.05）。性功能障碍的影响随着年龄的增长而恶化（勃起功能的比值比，每增加10岁为0.40; 95%可信区间，0.29-0.49; P < 0.001）。在7个时间点之间，性功能存在显著差异，术后8个月时出现最大恶化，随后缓慢但不完全恢复（P < 0.001）。预测模型显示对性功能障碍5个领域中的4个领域有足够的区分力（受试者工作特征曲线下面积> 0.70）。结论：放疗对性功能有不良影响，术后8个月影响最大。性功能障碍的风险可以在术前使用建议的指数进行量化，并可以帮助患者对他们接受的治疗类型做出更明智的选择。
Objectives: The objectives of this study were to evaluate the effect of radiotherapy (RT) on sexual function in patients undergoing oncologic resection for rectal cancer, and to develop a mathematical model for quantifying the risk of sexual dysfunction through time for this group of patients.Methods: Data were prospectively collected on patients undergoing proctosigmoidectomy (group 1: n = 101) or adjuvant radiotherapy (40-50 Gy) and resection (group 2: n = 100) for rectal cancer at a tertiary referral center between December 1998 and July 2004. Study end points were recorded at 7 time intervals (preoperatively, 4 months, 8 months, 1 year, 2 years, 3 years, and 4 years after surgery) and included: 1) ability to have an erection, 2) maintain an erection, 3) attain orgasm, 4) dry orgasm, and 5) whether they were sexually active. Multilevel logistic regression analysis for repeated measures was used to identify factors associated with the sexual dysfunction. A predictive model was developed and internally validated by comparing observed and model-predicted outcomes.Results: Radiotherapy had an adverse effect on the ability to get an erection, maintain an erection, attain orgasm, and being sexually active in comparison with patients undergoing surgery alone (7.4%, 12.6%, 16.2%, and 13.7% reduction 8 months after surgery respectively; P < 0.05). The effect of sexual dysfunction deteriorated with age (odds ratio for erectile function, 0.40 per 10-year increase in age; 95% confidence interval, 0.29-0.49; P < 0.001). A significant variability in sexual function was present among the 7 time points with a maximal deterioration occurring at 8 months after surgery with subsequent slow but not complete recovery (P < 0.001). The predictive model showed adequate discrimination on 4 of the 5 domains of sexual dysfunction (area under the receiver operating characteristic curve > 0.70).Conclusions: Radiotherapy has an adverse effect on sexual function, the effect being maximal at 8 months after surgery. The risk of sexual dysfunction can be quantified preoperatively using the proposed index and can assist patients in making better informed choices on the type of treatment they receive.