文章：

放疗或局部治疗后复发性前列腺癌患者接受挽救性根治性前列腺切除术后的患者报告结局与决策后悔评估

Patient-Reported Outcome Measures and Decision Regret After Salvage Radical Prostatectomy for Recurrent Prostate Cancer Following Radiotherapy or Focal Therapy

原文发布日期：25 January 2025

DOI: 10.3390/cancers17030396

类型: Article

开放获取: 是

英文摘要：

Background/Objectives: Radical prostatectomy (RP) may be considered for recurrent prostate cancer (PCa) following primary curative-intended local therapy. The effect of different prior therapies on patient-reported outcome measures (PROMs) after RP is not well defined. Methods: Validated PROMs (SF-12, EPIC-26, Decision Regret Scale) were used to compare health-related quality of life (HRQOL) and functional status changes following salvage RP after radiotherapy (RT-sRP) or focal therapy (FT-sRP), relative to primary RP. Results: Among 26,515 RP patients who underwent RP between 2014 and 2024, 107 (0.4%) previously received radiotherapy (RT-sRP) and 98 (0.4%) previously received focal therapy (FT-sRP). Compared with primary patients before RP, only the sexual function of RT-sRP patients was lower (EPIC score, 51 vs. 75,p< 0.001). One year after RP, RT-sRP patients exhibited lower functional status in all EPIC-26 domains compared to primary RP patients, whereas FT-sRP patients did not differ significantly. For instance, the median 1 yr EPIC-26 urinary incontinence scores were 46 (RT-sRP), 86 (FT-sRP), and 92 (primary RP). In adjusted mixed model analyses, the detrimental effects of RT-sRP vs. primary RP were further validated. In contrast, no such association was observed for FT-sRP. Decision regret and severe complications were low. Conclusions: Prior FT had only a marginal effect on HRQOL and functional status following RP, while urinary continence and sexual function were lower for RT-sRP patients as compared to primary RP patients. However, from an overall PROM perspective, prior therapies did not exert a prohibitive effect that would preclude RP as a treatment option in those patients.

摘要翻译： 

背景/目的：对于初始根治性局部治疗后复发性前列腺癌，可考虑采用根治性前列腺切除术。不同既往治疗方式对挽救性前列腺切除术后患者报告结局指标的影响尚未明确。方法：采用经过验证的PROM量表（SF-12、EPIC-26、决策后悔量表），比较放疗后挽救性前列腺切除术或局部治疗后挽救性前列腺切除术与初次前列腺切除术在健康相关生活质量和功能状态变化方面的差异。结果：在2014年至2024年间接受前列腺切除术的26,515例患者中，107例（0.4%）曾接受放疗，98例（0.4%）曾接受局部治疗。与术前初次治疗患者相比，仅放疗组患者的性功能评分较低（EPIC评分：51 vs. 75，p<0.001）。术后一年，放疗组患者在EPIC-26所有维度的功能状态均低于初次前列腺切除术患者，而局部治疗组患者无显著差异。例如，术后1年EPIC-26尿失禁评分中位数分别为：放疗组46分、局部治疗组86分、初次手术组92分。经混合模型校正分析，进一步验证了放疗组相较于初次手术组的不利影响，而局部治疗组未观察到类似关联。决策后悔率和严重并发症发生率均较低。结论：既往局部治疗对前列腺切除术后生活质量和功能状态影响有限，而放疗组患者的尿控功能和性功能较初次手术组显著降低。但从整体PROM视角评估，既往治疗并未产生禁止性影响，前列腺切除术仍可作为这些患者的治疗选择。

原文链接：

Patient-Reported Outcome Measures and Decision Regret After Salvage Radical Prostatectomy for Recurrent Prostate Cancer Following Radiotherapy or Focal Therapy