原发性输卵管癌66例临床分析

发布时间：2018-02-09 21:06

  本文关键词： 原发性输卵管癌 病理类型 术后残留肿瘤大小 淋巴结转移 预后　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:探究原发性输卵管癌的临床特点及影响预后因素。方法:收集2005年1月至2015年12月于山东大学齐鲁医院接受初始手术治疗,病理诊断为原发性输卵管癌的66例患者的临床资料,回顾性分析其临床特征。采用曼-惠特尼秩和检验分析早期及晚期患者术前血清CA-125、CA-153、CA-199水平是否存在差异;用Kaplan-Meier法描绘生存曲线、COX比例风险模型进行单因素及多因素生存分析,探讨原发性输卵管癌的预后因素。结果:患者平均年龄59.3岁(32-82岁),绝经期妇女50例(占78.5%)。临床表现为典型"三联征"即阴道排液/流血、腹痛、盆腔肿块者仅8例(12.1%),出现盆腔肿块伴阴道排液/流血或腹痛"二联征"者32例(48.5%),仅有其中一种临床表现者21例(31.8%),无以上三种症状者5例(7.6%)。根据2013年国际妇产科联合会(International Federation of Gynecology and Obstetrics,FIGO)手术病理分期:Ⅰ期14例,Ⅱ期9例,Ⅲ期41例,Ⅳ期2例。61例患者术前行血清CA-125检测,大于35U/ml者50例(82.0%),各期患者术前血清CA-125的阳性率为:Ⅰ期 57.1%(8/14);Ⅱ 期 55.6%(5/9);Ⅲ 期 97.2%(35/36),5 例未查;Ⅳ期100%(2/2)。早期(Ⅰ-Ⅱ期)及晚期(Ⅲ-Ⅳ期)患者术前血清CA-125水平存在显著差异(曼-惠特尼秩和检验Z=-3.988,P0.001),而术前血清CA-199、CA-153水平的差异不显著。术后病理根据WHO(2014)女性生殖器官肿瘤学分类分为:浆液性癌62例,均为高级别,黏液性癌1例、透明细胞癌2例,高级别浆液性腺癌部分伴肉瘤样分化1例。术后残留肿瘤大小:无肉眼残留者30例,残留肿瘤直径≤1cm者6例,残余肿瘤直径1cm者28例,未知残留肿瘤大小者2例。61例患者术后接受TP(紫杉醇+顺铂)/TC(紫杉醇+卡铂)/PC(顺铂+环磷酰胺)方案化疗,其中≥6疗程者45例。25例患者在随访过程中观察到复发,中位复发时间为末次化疗后12月(8-48月)。66例患者中位生存时间为48月,术后3年生存率为62.5%,5年生存率为35.6%。FIGO各期患者5年生存率分别为:Ⅰ 期 77.1%、Ⅱ 期 42.3%、Ⅲ 期 23.9%、Ⅳ 期 0(Log rank 检验,P0.001)。经COX多因素回归分析,残余肿瘤大小(HR=3.867,P=0.049)、病理类型(HR=19.024,P=0.023)及淋巴结是否转移(HR=0.167,P=0.024)是影响原发性输卵管癌患者总生存期的独立预后因素。结论:原发性输卵管癌多见于绝经期妇女,临床表现无特异性,多伴有血清CA-125升高,且CA-125水平与手术病理分期相关。最常见的组织学类型为高级别浆液性癌,治疗方式主要为手术辅以术后化疗。组织学类型、淋巴结是否转移及残留肿瘤大小与患者的预后密切相关。
[Abstract]:Objective: to investigate the clinical characteristics and prognostic factors of primary fallopian tube carcinoma. Methods: from January 2005 to December 2015, the patients received initial surgical treatment in Qilu Hospital, Shandong University. The clinical data of 66 patients with primary fallopian tube carcinoma diagnosed by pathology were analyzed retrospectively. The serum CA-125 CA-153 CA-199 levels in early and late stage patients were analyzed by Mann-Whitney rank sum test. Kaplan-Meier method was used to describe the survival curve and Cox proportional risk model was used to analyze the survival of single factor and multiple factors. To investigate the prognostic factors of primary fallopian tube carcinoma. Results: the mean age of the patients was 59.3 years old or 32-82 years old, 50 cases of menopausal women (78.5%). The clinical manifestations were typical "triple sign" (vaginal effusion / bleeding, abdominal pain). There were only 8 cases of pelvic mass with vaginal effusion / bleeding or abdominal pain. There were 32 cases of pelvic mass with vaginal effusion / bleeding or abdominal pain "duplex sign". There were only 21 cases with one clinical manifestation, 21 cases with 31. 8% and 5 cases without the above three symptoms. According to the 2013 International Federation of Obstetrics and Gynecology, the International Federation of Gynecology and Obstetrics and Obstetrics and Gynaecology and Obstetrics and Gynecology and Obstetrics and Gynecology. Federation of Gynecology and stetrics Figo: 14 cases with stage 鈪，

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