立体定向放疗联合内分泌治疗对转移性激素敏感性前列腺癌患者免疫功能和生活质量的影响

摘要 目的：探讨立体定向放疗（SBRT）联合内分泌治疗对转移性激素敏感性前列腺癌患者生活质量、免疫功能的影响。方法：选取我院2015年2月~2017年2月期间收治的转移性激素敏感性前列腺癌患者100例，根据信封抽签法将患者分为对照组（50例）和放疗组（50例），对照组给予内分泌治疗，放疗组在对照组的基础上联合SBRT治疗。对比两组前列腺特异性抗原（PSA）进展时间、PSA缓解率、治疗期间不良反应状况、3年生存率、免疫功能（CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺）和扩展性前列腺癌复合指数量表（EPIC）各项评分。结果：随访3年，对照组有2例失访、放疗组有3例失访，放疗组的PSA进展时间长于对照组（P<0.05），放疗组的3年生存率高于对照组（P<0.05）。治疗后，两组CD3⁺、CD4⁺/CD8⁺、CD4⁺均下降，但放疗组较对照组升高（P<0.05），两组治疗后CD8⁺均升高，但放疗组较对照组降低（P<0.05）。治疗后6个月，放疗组性功能、激素功能、泌尿功能、肠道功能领域评分均高于对照组（P<0.05）。两组不良反应总发生率、PSA缓解率组间对比无差异（P>0.05）。结论：SBRT联合内分泌治疗转移性激素敏感性前列腺癌患者，可延长患者PSA进展时间，减轻免疫抑制，提高患者生活质量，同时还可改善患者的预后，患者耐受性良好。

The Effect of Stereotactic Radiotherapy Combined with Endocrine Therapy on Immune Function and Quality of Life in Patients with Metastatic Hormone Sensitive Prostate Cancer

ABSTRACT Objective: To investigate the effect of stereotactic radiotherapy (SBRT) combined with endocrine therapy on the quality of life and immune function in patients with metastatic hormone sensitive prostate cancer. Methods: 100 patients with metastatic hormone sensitive prostate cancer in our hospital were selected from February 2015 to February 2018. According to envelope lottery method, the patients were divided into control group(50 cases) and radiotherapy group (50 cases). The control group was given endocrine therapy, and the radiotherapy group was treated with SBRT on the basis of the control group. The prostate specific antigen (PSA) progression time, PSA release rate, adverse reactions during treatment, 3-year survival rate, immune function(CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺) and expanded prostate cancer composite index(EPIC) scores in the two groups were compared. Results: 3 years after follow-up, 2 patients in the control group were lost to follow-up, and 3 patients in the radiotherapy group were lost to follow-up, the PSA progress time of radiotherapy group was longer than that of control group(P<0.05), the 3-year survival rate of radiotherapy group was higher than that of control group(P<0.05). After treatment, the CD3⁺, CD4⁺/CD8⁺, CD4⁺ in the two groups were decreased, but the radiotherapy group was higher than the control group (P<0.05), 6 months after treatment, CD8⁺ in the two groups were increased, but the radiotherapy group was lower than the control group(P<0.05). Six months after treatment, the scores of sexual function, hormone function, urinary function and intestinal function in the radiotherapy group were higher than those in the control group(P<0.05). There was no significant difference in the incidence of adverse reactions and PSA remission rate between the two groups (P>0.05). Conclusion: SBRT combined with endocrine therapy in patients with metastatic hormone sensitive prostate cancer can prolong the time of PSA progression time, reduce immune suppression, improve patients'' quality of life and also have a tendency to prolong the overall survival time of patients, and the patients are well tolerated.