对于乳腺癌女性，尿失禁症状通常被归咎于癌症治疗。不过，大约50%的非乳腺癌女性也会出现尿失禁症状。关于乳腺癌女性尿失禁症状的调查数据，大多来自已经完成治疗并且仍然可能接受内分泌治疗患者的回顾研究，故有必要开展前瞻研究，以确保尿失禁症状确实是癌症治疗的结果，而非原有问题或其他原因。
2020年6月，美国国家综合癌症网络《国家综合癌症网络杂志》发表加利福尼亚希望之城国家医学中心的研究报告，前瞻调查了女性早期乳腺癌术前新辅助或术后辅助治疗前后泌尿系统症状的发生比例及其影响。
该单中心前瞻研究于2015～2017年从加利福尼亚希望之城国家医学中心入组I～III期乳腺癌女性203例（年龄54.5±11.4岁）开始新辅助或辅助治疗之前和之后3个月时完成泌尿生殖症状量表和失禁影响问卷。如果治疗之前已经出现尿失禁，那么定义为原有尿失禁；如果治疗后3个月内发生尿失禁或尿失禁加重，那么定义为新发尿失禁；如果治疗后3个月内原有尿失禁未加重，那么定义为持续尿失禁。通过有序逻辑回归模型，确定原有尿失禁程度影响因素以及尿失禁影响生存质量程度的相关特征。
结果，根据治疗前调查，原有尿失禁占79.8%，其中膀胱过度活动症占29.1%、压力性尿失禁占10.8%、二者合并占39.9%。原有尿失禁程度与体重指数成正比（P<0.05）。
随后，其中200例患者开始治疗、163例患者完成治疗后调查，32例原无尿失禁患者新发尿失禁12例、131例原有尿失禁患者尿失禁加重27例。
根据生存质量评定，无论162例原有尿失禁、39例新发尿失禁还是94例持续尿失禁：
主观尿潴留程度中或重与轻或无相比：尿失禁对生存质量的影响程度高13.53倍（95%置信区间：4.28～42.79，P<0.001）
尿失禁症状程度严重与中等至无相比：尿失禁对生存质量的影响程度高6.31倍（95%置信区间：3.24～12.27，P<0.001）
尿失禁症状数量两个与一个相比：尿失禁对生存质量的影响程度高3.50倍（95%置信区间：2.02～6.08，P<0.001）
体重指数每增加一个单位：尿失禁对生存质量的影响程度高1.06倍（95%置信区间：1.02～1.11，P=0.003）
对上述影响因素进行校正后，新发尿失禁与原有或持续尿失禁相比，对生存质量的影响程度低60%（比值比：0.40，95%置信区间：0.17～0.94，P=0.036）。
因此，该研究结果表明，乳腺癌确诊时将近80%的女性原有尿失禁，尤其对于肥胖女性。新辅助或辅助治疗后，新发尿失禁或原有尿失禁加重分别占37.5%和20.6%，而前者对生存质量的影响相对较轻，故临床医师需要适当调整治疗策略，尤其对于原有尿失禁女性。
J Natl Compr Canc Netw. 2020 Jun;18(6):712-716.
Serial Assessment of Urinary Incontinence in Breast Cancer Survivors Undergoing (Neo)Adjuvant Therapy.
Chung CP, Behrendt C, Wong L, Flores S, Mortimer JE.
City of Hope National Medical Center, Duarte, California.
BACKGROUND: Among breast cancer survivors, urinary incontinence (UI) is often attributed to cancer therapy. We prospectively assessed urinary symptoms before and after (neo)adjuvant treatment of early-stage breast cancer.
METHODS: With consent, women with stage I-III breast cancer completed the Urogenital Distress Inventory and the Incontinence Impact Questionnaire before and 3 months after initiating (neo)adjuvant therapy. Patients with UI were at least slightly bothered by urinary symptoms. If UI was present pretreatment, it was considered prevalent; if UI was new or worse at 3 months posttreatment, it was considered incident; if prevalent UI was no worse at 3 months posttreatment, it was considered stable. Ordinal logistic regression models identified characteristics associated with the level of prevalent UI and with the degree of UI impact on quality of life (QoL).
RESULTS: On pretreatment surveys, participants (N=203; age 54.5 ± 11.4 years) reported 79.8% prevalence of UI, including overactive bladder (29.1%), stress incontinence (10.8%), or both (39.9%). The level of prevalent UI increased with body mass index (BMI; P<.05). Of 163 participants assessed at both time points, incident UI developed in 12 of 32 patients without prevalent UI and 27 of 131 patients with prevalent UI. Regardless of whether UI was prevalent (n=162), incident (n=39), or stable (n=94) at QoL assessment, the impact of UI increased (P<.01) with the number and severity of UI symptoms, subjective urinary retention, and BMI. Adjusted for those characteristics, incident UI had less impact on QoL (P<.05) than did prevalent or stable UI.
CONCLUSIONS: We found that UI is highly prevalent at breast cancer diagnosis and that new or worsened UI is common after (neo)adjuvant therapy. Because UI often impairs QoL, appropriate treatment strategies are needed.
PMID: 32502980
DOI: 10.6004/jnccn.2020.7535
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