前列腺癌治疗后的长期不良影响和并发症
Joseph M Unger1, Cathee Till1, Catherine M Tangen1
1SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, Washington.
JAMA oncology
|November 7, 2024
概括
前列腺癌的治疗方法,如前列腺切除术和放射治疗,显著增加长期泌尿,性和其他并发症的风险. 这些发现强调需要对患者进行仔细的咨询,以了解前列腺癌 (PCA) 治疗风险和益处.
科学领域:
- 在瘤学瘤学.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 老年医学 老年医学
背景情况:
- 前列腺癌 (PCA) 通常是惰的,需要在癌症控制和与治疗相关的疾病之间保持谨慎的平衡.
- 对PCA的治疗决定需要权衡潜在的益处与长期不良影响的风险.
研究的目的:
- 为了比较长期治疗相关的不良影响和并发症在治疗PCA的患者与老年男性的一般人群.
- 量化前列腺切除术和PCA放射治疗后特定并发症的增加危险风险.
主要方法:
- 一项队列研究将两项大型PCA预防临床试验的数据与Medicare索赔记录联系起来.
- 包括经过前列腺切除或放射治疗的PCA患者,与未经治疗的对照组相比.
- 使用多变量考克斯回归分析,对相关共变量进行调整,并按研究组分层.
主要成果:
- 前列腺切除术与尿路或性并发症的危险风险增加了7.23倍,而放射治疗与未接受治疗的个人相比增加了2.76倍.
- 放射治疗患者患膀癌的风险增加了近3倍,放射性囊炎和直肠炎的风险显著增加.
- 治疗相关并发症的发生率每1000人/年为前列腺切除术的124.26,放射治疗的62.15和未接受治疗的参与者的23.61.
结论:
- 经过PCA治疗,在治疗后的12年内,即使考虑到与年龄相关的因素,PCA治疗也与更高的并发症率有关.
- 这些发现强调了患者咨询PCA查和治疗风险的重要性.
- 为优先考虑前列腺癌预防策略提供了一个理由.
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