Прогностичні фактори нетримання сечі після радикальної простатектомії з приводу неметастатичного раку простати, пов’язані з хворим та пухлиною: систематичний огляд та метааналіз
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Анотація
Незважаючи на те, що нетримання сечі (НС) виникає після радикальної простатектомії (РП) достатньо часто, наразі, до кінця незрозуміло, які фактори дійсно збільшують ризик розвитку НС.
Наведено результати систематичного огляду прогностичних факторів, пов’язаних з хворим та пухлиною, що викликають постпростатектомічне нетримання сечі (ППЕ НС). Первинні результати оцінювали наявність НС протягом 3 міс після виконання РП. Вторинні результати включали збереження НС через 3–12 міс та >12 міс після РП.
Проведено дослідження баз даних, що включали Medline, EMBASE та CENTRAL у період із січня 1990 року до червня 2022 року. Були включені статті, що повідомляли про прогностичні фактори, пов’язані з пацієнтами та пухлинами, з моно- та мультиваріантним аналізом. Хірургічні фактори впливу були виключені. Оцінювання ризику упередження (RoB) проводили за допомогою показників Quality In Prognosis Studies (QUIPS). Рандом-ефективний метааналіз виконували для всіх прогностичних факторів, де це було можливо.
Проаналізовано загалом 83 дослідження (5 рандомізованих контрольованих досліджень, 15 проспективних, 61 ретроспективне і 2 дослідження типу «випадок-контроль») за участю 55 302 пацієнти. Значущими прогностичними факторами для післяопераційного НС протягом 3 міс після РП були вік, довжина мембранозної уретри (ДМУ), об’єм передміхурової залози (ОПЗ) та індекс коморбідності Чарлсона (ІКЧ).
Результати аналізу літератури свідчать, що збільшення віку, коротший ДМУ, більший ОПЗ та вищий ІКЧ є незалежними прогностичними факторами для нетримання сечі протягом 3 міс після РП. Водночас усі, крім ІКЧ, залишаються прогностично значущими для терміну 3–12 міс після операції.
Виявлено, що збільшення віку, збільшення об’єму передміхурової залози, менша довжина мембранозної уретри і нижча фізична форма були пов’язані з гіршим нетриманням сечі протягом перших 3 міс після операції. Протягом наступних 3–12 післяопераційних місяців прогностичними факторами залишалися всі, крім фізичної тренованості.
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