宫颈癌根治术后复发或未控的临床病理因素分析及再治疗的疗效分析

发布时间：2018-06-02 03:37

本文选题：宫颈癌 + 根治术　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨宫颈癌经根治性手术治疗后复发或未控的临床及病理因素,为宫颈癌的治疗提供参考。方法:回顾性分析2010年4月至2014年4月广西医科大学附属肿瘤医院妇瘤科收治的550例IA2期-IIB期宫颈癌患者的病例资料,收集全部患者的临床病理资料及随访资料,采用SPSS22.0统计学软件包进行统计学分析,共纳入13个临床及病理因素,首先进行单因素分析,将单因素分析中有意义的因素纳入Logistic回归模型进行多因素分析。结果:(1)经根治性手术治疗后的550例宫颈癌患者中,复发或未控的患者有103例,占18.7%。(2)单因素分析结果显示:临床分期、肿瘤大小、组织分化程度、肿瘤浸润深度、宫旁浸润、脉管癌栓、淋巴结转移、切缘、新辅助化疗及术后辅助治疗共10个临床病理因素是宫颈癌根治术后复发或未控的影响因素。(3)多因素分析结果显示:临床分期、肿瘤大小、淋巴结转移、脉管癌栓、切缘、新辅助化疗及术后辅助放化疗共7个临床病理因素是宫颈癌根治术后复发的独立因素(p0.05)。其中临床分期晚、肿瘤直径≥4cm、淋巴结转移、脉管癌栓、切缘阳性的OR值均大于1,是宫颈癌根治术后复发或未控的危险因素;新辅助化疗及术后放化疗的OR值均小于1,是宫颈癌根治术后复发或未控的保护因素。结论:临床分期晚、肿瘤直径≥4cm、淋巴结转移、脉管癌栓、切缘阳性是宫颈癌术后复发或未控的危险因素,新辅助化疗及术后放化疗有利于减少术后复发。目的:回顾性研究宫颈癌根治术后复发或未控的再治疗方式及疗效,为宫颈癌术后复发或未控的治疗提供参考。方法:回顾性分析2010年4月至2014年4月广西医科大学附属肿瘤医院妇瘤科收治的97例IB1期-IIB期宫颈癌根治术后复发或未控患者,分析患者术后复发或未控的时间、首发症状、复发或未控部位、复发或未控后的治疗方式及疗效等。结果:(1)97例宫颈癌复发或未控患者中,45例患者确诊复发或未控时未有不适症状或体征,占46%;另52例患者常见的症状有阴道流液、腰骶部及大腿部疼痛、下肢肿胀等。(2)宫颈癌根治术后复发或未控的时间为1-40个月,中位时间13个月,平均时间12.0±7.5个月;1年内复发或未控占49.5%、2年内复发和未控占94.8%;常见的复发或转移部位有盆腔、阴道残端、骨、肺、肝等。(3)宫颈癌根治术后复发或未控患者的生存时间为2-60个月,中位生存时间为10个月,平均生存时间为13.3±10.4个月。(4)宫颈癌根治术后复发或未控患者的1年生存率为44.1%,2年生存率为16.7%,3年生存率为7.3%。(5)治疗后生存时间比较:各治疗组的平均生存时间整体比较具有统计学差异,两两比较提示:手术+放化疗组优于放疗组、化疗组;放化疗组优于化疗组。中位生存时间比较:手术+放化疗组手术组放化疗组放疗组化疗组。(6)治疗后近期疗效比较:各治疗组的有效率整体比较具有统计学差异,两两比较提示:手术组、放疗组、放化疗组及手术+放化疗组的有效率均优于化疗组。(7)治疗后生存率比较:各治疗组的生存率整体比较具有统计学差异;两两比较提示:手术+放化疗组生存率优于放疗组、化疗组、放化疗组;手术组生存率优于化疗组;放化疗组优于化疗组。(8)阴道残端复发或未控后各治疗方式疗效比较提示:患者经手术+放化疗治疗后的平均生存时间、中位生存时间及1、2、3年生存率均为各治疗组中最优。(9)盆腔复发或未控后各治疗方式疗效比较提示:手术组、放疗组、化疗组及放化疗组在近期疗效及1、2、3年生存率方面的比较均无统计学差异。结论:(1)宫颈癌根治术后复发多在2年内,起病隐匿,术后应加强随访。(2)宫颈癌根治术后复发或未控患者预后差。(3)手术+放化疗是宫颈癌根治术后复发或未控患者的最佳治疗方法。
[Abstract]:Objective: To explore the clinical and pathological factors of recurrent or uncontrolled cervical cancer after radical operation, and to provide a reference for the treatment of cervical cancer. Methods: a retrospective analysis of 550 cases of IA2 -IIB cervical cancer patients admitted to the Department of cancer hospital, affiliated to Guangxi Medical University, from April 2010 to April 2014, was reviewed. The bed pathological data and follow-up data were statistically analyzed with SPSS22.0 statistics software package. 13 clinical and pathological factors were included. First, single factor analysis was carried out. The significant factors in the single factor analysis were included in the Logistic regression model for multifactor analysis. Results: (1) 550 cases of cervical cancer patients after radical operation treatment. 103 cases of recurrent or uncontrolled patients, accounting for 18.7%. (2) single factor analysis, showed that 10 clinicopathological factors, including clinical staging, tumor size, degree of tissue differentiation, invasion depth of the tumor, intrastalal infiltration, vascular tumor thrombus, lymph node metastasis, cutting edge, neoadjuvant chemotherapy and postoperative adjuvant therapy were the recurrence or uncontrolled shadow of cervical cancer after radical resection. (3) the results of multiple factors analysis showed that clinical stages, tumor size, lymph node metastasis, vascular tumor thrombus, cutting edge, neoadjuvant chemotherapy and postoperative adjuvant chemotherapy were independent factors of recurrence after radical resection of cervical cancer (P0.05). The clinical stages were late, tumor diameter was more than 4cm, lymph node metastasis, vascular tumor thrombus, tangential Yang The OR value of sex is more than 1, which is a risk factor for recurrent or uncontrolled cervical cancer. The OR value of neoadjuvant chemotherapy and postoperative radiotherapy and chemotherapy is less than 1. It is a protective factor for recurrent or uncontrolled cervical cancer after radical operation. Conclusion: the clinical stage is late, the diameter of the tumor is more than 4cm, lymph node metastasis, pulse tube cancer thrombus, and the positive margin of cutting edge is the recurrence or failure of cervical cancer after operation. Control risk factors, neoadjuvant chemotherapy and postoperative radiotherapy and chemotherapy are beneficial to reduce postoperative recurrence. Objective: retrospective study of recurrent or uncontrolled retreatment after radical resection of cervical cancer, and to provide a reference for recurrent or uncontrolled treatment of cervical cancer. Methods: a retrospective analysis of the Affiliated Tumor of Guangxi Medical University from April 2010 to April 2014. 97 cases of recurrent or uncontrolled patients after IB1 -IIB radical resection of cervical cancer were treated in the Department of Hospital Department of gynaecoma. The recurrence or uncontrolled site, recurrent or uncontrolled treatment and curative effect were analyzed. Results: (1) in 97 cases of recurrent or uncontrolled cervical cancer, 45 patients had no recurrence or control. Symptoms or signs of discomfort accounted for 46%, the other 52 cases were common symptoms of vaginal fluid, lumbosacral and thigh pain, lower limb swelling, etc. (2) the recurrence or uncontrolled time of cervical cancer after radical resection was 1-40 months, median time was 13 months, the average time was 12 + 7.5 months, 1 years had relapsed or uncontrolled 49.5%, 2 years recurred and 94.8% uncontrolled in 2 years. The recurrent or metastatic sites were pelvic cavity, vaginal stump, bone, lung, liver, etc. (3) the survival time of the recurrent or uncontrolled patients after radical cervical cancer was 2-60 months, the median survival time was 10 months, the average survival time was 13.3 + 10.4 months. (4) the 1 year survival rate of recurrent or uncontrolled patients after cervical cancer was 44.1%, and the 2 year survival rate was 16.7%, 3. The survival time of the annual survival rate was 7.3%. (5) after treatment: the overall comparison of the average survival time of the treatment groups was statistically different. The 22 comparison suggested that the operation + radiotherapy and chemotherapy group was superior to the radiotherapy group and chemotherapy group; the radiotherapy and chemotherapy group was superior to the chemotherapy group. The median survival time was compared: the operation group in the operation group of hand + radiotherapy and chemotherapy group was treated with radiotherapy group chemotherapy group (6). Comparison of the short-term effect after treatment: the overall efficiency of the treatment groups had statistical differences. 22 the comparison showed that the effective rate of the operation group, the radiotherapy group, the radiotherapy and chemotherapy group and the operation + radiotherapy and chemotherapy group were superior to those in the chemotherapy group. (7) the survival rate after treatment was compared: the overall comparison of the survival rate of the treatment groups was statistically different; 22 the comparison suggests hand: hand The survival rate of the operation plus radiotherapy group was superior to the radiotherapy group, the chemotherapy group and the radiotherapy and chemotherapy group, the survival rate of the operation group was better than the chemotherapy group, and the radiotherapy and chemotherapy group was superior to the chemotherapy group. (8) the comparison of the curative effect of the recurrent or uncontrolled vaginal stump after the recrudescence or uncontrolled treatment of the vaginal stump showed that the average survival time, the median survival time and the 1,2,3 year survival rate of the patients after the operation plus radiotherapy and chemotherapy were all treated by each treatment. The treatment group was the best. (9) the comparison of the curative effect of the recurrent or uncontrolled treatment of pelvic cavity showed that there was no statistical difference between the operation group, the radiotherapy group, the chemotherapy group and the radiotherapy and chemotherapy group in the short term curative effect and the 1,2,3 year survival rate. Conclusion: (1) the recurrence of the cervical cancer after radical resection is 2 years, the onset of the disease is hidden, and the follow-up should be strengthened. (2) radical cervical cancer radical cure Postoperative recurrence or uncontrolled patients have poor prognosis. (3) surgery plus radiotherapy and chemotherapy is the best treatment for recurrent or uncontrolled cervical cancer patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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