Multinational Prospective Study of Patient-Reported Outcomes After Prostate Radiation Therapy: Detailed Assessment of Rectal Bleeding

作者：Lee Jae Y; Daignault Newton Stephanie; Heath Gerard; Scarlett Sarah; Sanda Martin G; Chang Peter; Regan Meredith M; Michalski Jeff M; Sandler Howard M; Feng Felix Y; Kuban Deborah A; Zietman Anthony L; Ciezki Jay P; Kaplan Irving D; Crociani Catrina; McLaughlin William P; Mantz Constantine A; Finkelstein Steven E; Suy Simeng; Collins Sean P; Garin Olatz; Ferrer Montserrat; Hamstra Daniel A; Spratt Daniel E^*

来源：International Journal of Radiation Oncology, Biology, Physics, 2016, 96(4): 770-777.

DOI：10.1016/j.ijrobp.2016.07.038

Purpose: The new short Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) patient-reported health-related quality of life (HRQOL) tool has removed the rectal bleeding question from the previous much longer version, EPIC-26. Herein, we assess the impact of losing the dedicated rectal bleeding question in 2 independent prospective multicenter cohorts.
Methods and Materials: In a prospective multicenter test cohort (n=865), EPIC-26 patient-reported HRQOL data were collected for 2 years after treatment from patients treated with prostate radiation therapy from 2003 to 2011. A second prospective multicenter cohort (n=442) was used for independent validation. A repeated-effects model was used to predict the change from baseline in bowel summary scores from longer EPIC instruments using the change in EPIC-CP bowel summary scores with and without rectal bleeding scores.
Results: Two years after radiation therapy, 91% of patients were free of bleeding, and only 2.6% reported bothersome bleeding problems. Correlations between EPIC-26 and EPIC-CP bowel scores were very high (r(2) =0.90-0.96) and were statistically improved with the addition of rectal bleeding information (r(2) =0.94-0.98). Considering all patients, only 0.2% of patients in the test cohort and 0.7% in the validation cohort reported bothersome bleeding and had clinically relevant HRQOL changes missed with EPIC-CP. However, of the 2.6% (n=17) of men with bothersome rectal bleeding in the test cohort, EPIC-CP failed to capture 1 patient (6%) as experiencing meaningful declines in bowel HRQOL.
Conclusions: Modern prostate radiation therapy results in exceptionally low rates of bothersome rectal bleeding, and <1% of patients experience bothersome bleeding and are not captured by EPIC-CP as having meaningful HRQOL declines after radiation therapy. However, in the small subset of patients with bothersome rectal bleeding, the longer EPIC-26 should strongly be considered, given its superior performance in this patient subset.

• 出版日期2016-11-15