局限性前列腺癌患者治疗决策与生存预期的相关性研究

Correlation between treatment decision and life expectancy in localized prostate cancer patients

目的 考察局限性前列腺癌(localized prostate cancer,LPC)患者的治疗选择[手术、放疗或观察等待/积极监测(watchful waiting or active surveillance,WW/AS)]与自我报告的主观生存预期的关系,同时确定患者主观生存预期的影响因素。方法 前瞻性纳入2019年3月至2022年1月在浙江省台州医院门诊和住院诊疗的180例LPC患者。根据治疗方案不同,将患者分为手术组(n=103)、放疗组(n=54)和WW/AS组(n=23)。所有患者填写问卷,内容包括受试者选择的治疗方案(手术、放疗或WW/AS)、基于此方案的生命预期(LE2)、如不进行治疗的生命预期(LE_(1)),ΔLE=LE_(2)-LE_(1)。比较治疗和不治疗前列腺癌时患者主观生存期望的差异、选择不同治疗方案的患者主观生存期望的差异(ΔLE),采用多元线性回归分析模型考察患者主观生存预期长短的影响因子。结果 如果不接受任何治疗,33.3%的患者主观生存预期不足5年,只有5.0%的患者主观生存期望超过20年;而选择积极治疗的患者主观生存预期低于5年的仅占3.3%,超过20年的占53.9%。未调整LE前,手术组和放疗组ΔLE均高于WW/AS组,差异有统计学意义(P<0.05)。调整LE后,手术组和放疗组ΔLE均高于WW/AS组,差异有统计学意义(P<0.05)。年龄和所选择的治疗方案是主观生存预期差异的影响因子。结论 大多数LPC患者在不接受治疗的情况下低估了生存预期,而在接受手术或放疗的情况下高估了生存预期。这些不切实际的主观生存预期可能会导致治疗过度,决策后悔,并降低治疗后的生活质量。

Objective To investigate the relationship between treatment options [surgery, radiotherapy, or watchful waiting or active surveillance(WW/AS)] and self-reported subjective survival expectations in patients with localized prostate cancer(LPC),and to determine the influencing factors of subjective survival expectations in patients. Methods A total of 180 patients with LPC were prospectively enrolled from March 2019 to January 2022.According to the selected treatment regimen, the patients were divided into surgery group(n=103), radiotherapy group(n=54) and WW/AS group(n=23). All patients filled out a questionnaire containing the treatment regimen chosen by the subject(surgery, radiotherapy or WW/AS), life expectancy based on this regimen(LE_(2)), life expectancy if no treatment was performed(LE_(1)), ΔLE=LE_(2)-LE_(1). Compared the difference of subjective survival expectation between patients treated with prostate cancer and those not treated with prostate cancer, and the difference of subjective survival expectation(ΔLE) between patients selected different treatment regimens, multiple linear regression analysis model was used to investigate the influencing factors of subjective survival expectation. Results Without any treatment, 33.3%of patients had subjective survival expectations of less than 5 years, and only 5.0% had subjective survival expectations of more than 20 years;while only 3.3% of patients who chose active treatment had subjective survival expectations of less than 5 years and 53.9% had subjective survival expectations of more than 20 years. Before adjusting for LE, ΔLE was higher in both the surgery and radiotherapy groups than in the WW/AS group, with a statistically significant difference(P<0.05). After adjustment for LE, ΔLE was higher in both the surgery and radiotherapy groups than in the WW/AS group, and the difference was statistically significant(P<0.05). Age and treatment regimen chosen were factors influencing the expected differences in subjective survival. Conclusion Most patients with LPC underestimate survival expectations without treatment, whereas they overestimate survival expectations with surgery or radiotherapy.These unrealistic subjective survival expectations may lead to overtreatment, decision regret, and reduced quality of life after treatment.