摘要
目的 探讨比卡鲁胺联合经尿道前列腺切除术(TURP)治疗晚期前列腺癌合并膀胱出口梗阻(BOO)的效果及预后.方法 前瞻性选取2018年7月至2021年11月海南省肿瘤医院收治的70例晚期前列腺癌合并BOO患者作为研究对象.按照随机数字表法将其分为观察组(n=35)及对照组(n=35).对照组采用TURP治疗,观察组采用比卡鲁胺联合TURP治疗.比较两组治疗前、治疗3个月后症状改善情况[采用国际前列腺症状评分(IPSS)评估],比较两组治疗前、治疗3个月后尿动力学[平均尿流率(Qave)、残余尿量、最大尿流率(Qmax)]、免疫功能(CD3+、CD4+和CD4+/CD8+)、肿瘤标志物[血管内皮生长因子(VEGF)、前列腺特异性抗原(PSA)]及预后.结果 观察组治疗3个月后梗阻症状评分、刺激症状评分、IPSS总分分别为(3.95±0.62)、(5.01±1.24)、(8.96±1.73)分,均低于对照组[(5.74±0.96)、(7.28±1.56)、(13.02±2.59)分],差异均有统计学意义(P＜0.05).观察组治疗3个月后Qave、Qmax分别为(8.75±1.92)mL/s、(11.17±2.52)mL/s,均高于对照组[(6.48±1.65)mL/s、(8.96±1.93)mL/s],残余尿量为(37.81±4.63)mL,低于对照组[(49.75±6.94)mL],差异均有统计学意义(P＜0.05).观察组治疗3个月后CD3+、CD4+、CD4+/CD8+分别为(63.06±7.28)％、(42.79±4.35)％、1.63±0.29,均高于对照组[(59.25±6.64)％、(39.81±4.02)％、1.39±0.24],差异均有统计学意义(P＜0.05).观察组治疗3个月后的血清VEGF、PSA水平分别为(76.89±12.34)μg/mL、(6.93±1.06)ng/mL,均低于对照组[(94.67±15.63)μg/mL、(8.32±1.57)ng/mL],差异均有统计学意义(P＜0.05).观察组治疗后12个月生存率为97.14％,高于对照组(82.86％),差异有统计学意义(P＜0.05).结论 比卡鲁胺联合TURP术治疗晚期前列腺癌合并BOO的疗效确切,能缓解患者前列腺症状,促进尿动力学恢复,提高免疫功能,调节肿瘤标志物水平,改善预后,值得临床推广应用.
Abstract
Objective To explore the effect and prognosis of bicalutamide combined with transurethral resection of prostate(TURP)in the treatment of advanced prostate cancer(PCa)combined with bladder outlet obstruction(BOO).Methods A total of 70 patients with ad-vanced prostate cancer combined with BOO admitted to Hainan Cancer Hospital from July 2018 to November 2021 were prospectively selected as the study subjects.According to the random number table method,they were divided into the observation group(n=35)and the control group(n=35).The control group was treated with TURP,while observation group was additionally treated with bicalutamide.The symptoms improve-ment before and after 3 months of treatment was compared between two groups[evaluated using the international prostate symptom score(IPSS)],and urodynamics[mean urine flow rate(Qave),residual urine volume,maximum urine flow rate(Qmax)],immune function(CD3+,CD4+and CD4+/CD8+),tumor markers[vascular endothelial growth factor(VEGF)and prostate specific antigen(PSA)]before and after 3 months of treatment and prognosis were compared between the two groups.Results After 3 months of treatment,the obstruction symptom score,stimulation symptom score,and IPSS total score of the observation group were(3.95±0.62),(5.01±1.24),and(8.96±1.73)points,respectively,which were lower than those of the control group[(5.74±0.96),(7.28±1.56),and(13.02±2.59)points],and the differences were sta-tistically significant(P＜0.05).After 3 months of treatment,the Qave and Qmax in the observation group were(8.75±1.92)mL/s and(11.17±2.52)mL/s,respectively,which were higher than those in the control group[6.48±1.65)mL/s and(8.96±1.93)mL/s],the residual urine volume was(37.81±4.63)mL,which was lower than that in the control group[49.75±6.94)mL],and the differences were statistically significant(P＜0.05).After 3 months of treatment,the levels of CD3+,CD4+,and CD4+/CD8+in the observation group were(63.06±7.28)％,(42.79±4.35)％,and 1.63±0.29,respectively,which were higher than those in the control group[59.25±6.64)％,(39.81±4.02)％,and 1.39±0.24],and the differences were statistically significant(P＜0.05).After 3 months of treatment,the levels of serum VEGF and PSA in the observation group were(76.89±12.34)μg/mL and(6.93±1.06)ng/mL,respectively,which were lower than those in the control group[(94.67±15.63)μg/mL and(8.32±1.57)ng/mL],and the differences were statistically significant(P＜0.05).At 12 months after treatment,survival rate in observation group was 97.14％,which was higher than that in control group(82.86％),and the difference was statistically significant(P＜0.05).Conclusion Curative effect of bicalutamide combined with TURP is significant on advanced PCa combined with BOO,which can alleviate prostate symptoms,promote urodynamics recovery,enhance immune function,regulate levels of tumor markers and improve prognosis.It is worth clinical promotion and application.
基金项目
海南省自然科学基金高层次人才项目(822RC851)
维普
万方数据