戈舍瑞林联合比卡鲁胺间歇性与连续性治疗对前列腺癌患者前列腺抗原及免疫功能的影响

Effects of intermittent and continuous goserrelin combined with bicalutamide on prostate antigen and immune function in patients with prostate cancer

目的探讨戈舍瑞林联合比卡鲁胺间歇性与连续性治疗对前列腺癌患者前列腺抗原及免疫功能的影响。方法前瞻性选取2022年2月至2023年1月成都市第三人民医院肿瘤科收治的110例前列腺癌患者,按照入院单双号分为对照组和研究组,每组各55例。对照组行戈舍瑞林联合比卡鲁胺连续性治疗。研究组患者给予同药物的间歇性治疗方案。两组均干预治疗9个月。比较两组患者治疗前及治疗后第1、3、9个月的血清前列腺特异性抗原(PSA)、游离前列腺特异性抗原(f-PSA)、血管内皮生长因子(VEGF)水平,外周血T细胞亚群(CD3+、CD4+、CD4+/CD8+比例)以及免疫功能指标[免疫球蛋白(Ig)A、IgG、自然杀伤(NK)细胞]水平。同时比较两组治疗安全性。结果治疗后1、3、9个月,两组患者PSA、f-PSA、VEGF水平均治疗前明显改善,差异均有统计学意义(P<0.05);两组患者治疗后1、3个月的PSA、f-PSA水平及治疗后1、3、9个月VEGF水平比较,差异均无统计学意义(P>0.05),而研究组治疗后9个月PSA、f-PSA水平分别为(4.22±3.04)、(1.38±1.95)ng/mL,均低于对照组[(5.36±2.98)、(1.92±2.05)ng/mL],差异均有统计学意义(P<0.05)。治疗后1、3、9个月,两组患者CD3+、CD4+、CD4+/CD8+水平均较治疗前明显改善,差异均有统计学意义(P<0.05);两组治疗后1、3、9个月CD3+、CD4+/CD8+以及治疗后1、3个月CD4+水平比较,差异均无统计学意义(P>0.05),研究组患者治疗后9个月CD4+水平为(34.38±3.14)%,明显低于对照组[(36.02±3.17)%],差异有统计学意义(P<0.05)。治疗后1、3、9个月,两组患者IgA、IgG、NK细胞水平均较治疗前明显改善,差异均有统计学意义(P<0.05);两组患者治疗后1、3、9个月IgA、IgG、NK细胞水平比较,差异均无统计学意义(P>0.05)。两组患者各种不良反应发生率比较,差异均无统计学意义(P>0.05)。两组患者治疗总满意度比较,差异无统计学意义(P>0.05)。结论戈舍瑞林联合比卡鲁胺间歇性与连续性治疗均能有效地调节前列腺癌患者PSA、f-PSA、VEGF指标及免疫功能,且安全性和患者满意度高,值得临床推广应用。

Objective To investigate the effect of goserelin combined with bicalutamide intermittent and continuous treatment on prostate antigen and immune function in patients with prostate cancer.Methods A total of 110 patients with prostate cancer admitted to the Department of Oncology,the Third People's Hospital of Chengdu from February 2022 to January 2023 were prospectively selected and divided into control group and study group according to the odd and even number of admission,with 55 cases in each group.Patients in the control group received continuous treatment with goserrelin and bicalutamide.Patients in the study group were given an intermittent treatment regimen with the same drug.Both groups were treated for 9 months.Serum prostate-specific antigen(PSA),free prostate-specific antigen(f-PSA),vascular endothelial growth factor(VEGF)levels,peripheral blood T cell subsets CD3+,CD4+,CD4+/CD8+ratio and immune function indexes[immunoglobulin(Ig)A,IgG,natural killer(NK)cells]levels before treatment and at 1,3,9 months after treatment were compared between the two groups.At the same time,the therapeutic safety of the two groups were compared.Results At 1,3 and 9 months after treatment,the levels of PSA,f-PSA and VEGF in the two groups were significantly improved before treatment,and the differences were statistically significant(P<0.05);there were no statistically significant differences in PSA and f-PSA levels between the two groups at 1 and 3 months after treatment and VEGF levels at 1,3 and 9 months after treatment(P>0.05);the levels of PSA and f-PSA in the study group at 9 months after treatment were(4.22±3.04)and(1.38±1.95)ng/mL,respectively,which were lower than those in the control group[(5.36±2.98)and(1.92±2.05)ng/mL],and the differences were statistically significant(P<0.05).At 1,3 and 9 months after treatment,the levels of CD3+,CD4+and CD4+/CD8+in the two groups were significantly improved before treatment,the differences were statistically significant(P<0.05).There were no statistically significant differences in the levels of CD3+,CD4+/CD8+at 1,3 and 9 months after treatment and CD4+at 1,3 months after treatment between the two groups(P>0.05);the level of CD4+at 9 months after treatment in the study group was(34.38±3.14)%,which was significantly lower than that in the control group[(36.02±3.17)%],and the difference was statistically significant(P<0.05).At 1,3 and 9 months after treatment,the levels of IgA,IgG and NK cells in the two groups were significantly improved before treatment,and the differences were statistically significant(P<0.05).There were no statistically significant difference in the levels of IgA,IgG and NK cells between the two groups at 1,3 and 9 months after treatment(P>0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).There was no statistically significant difference in the total satisfaction of treatment between the two groups(P>0.05).Conclusion Goserelin combined with bicalutamide intermittent and continuous treatment can effectively regulate the PSA,f-PSA,VEGF index and immune function of prostate cancer patients,and the safety and patient satisfaction are high,which is worthy of clinical application.