影响Ⅰb2-Ⅱb期宫颈癌新辅助化疗近期疗效的相关因素分析
发布时间：2018-08-12 18:19
【摘要】：目的:探讨影响Ib2-IIb期宫颈癌新辅助化疗近期疗效的相关因素。方法:回顾性分析2010年6月至2016年7月间就诊于大连医科大学附属第二医院和大连市妇产医院妇产科患者的相关临床资料,所有患者均经病理检查证实为宫颈癌且住院接受新辅助化疗(NACT)治疗。根据患者的病理类型、病理分级、临床分期、化疗方案、化疗疗程、宫颈癌组织血流情况等不同因素进行分组。对比化疗前后宫颈肿块大小变化,按照WHO(World Health Organization,世界卫生组织)实体瘤疗效评价标准统计各组完全缓解、部分缓解、无变化、进展等例数,根据公式总例数部分缓解例数)(完全缓解例数有效率??(10)(28)100%计算有效率。并对所得数据行多因素非线性二分类logistic回归分析。结果:1.病理类型:鳞癌组共85例,有效率为70.6%,包括:完全缓解(CR)5例,部分缓解(PR)63例,无变化(NC)14例,进展(PD)3例;腺癌组共10例,有效率为10%,包括:PR 1例,NC 6例,PD 3例;其他组共4例,有效率为25%,包括:PR 1例,NC 1例,PD 2例,其病理类型为腺鳞癌、乳头状鳞癌、神经内分泌癌;鳞癌对新辅助化疗近期疗效的影响明显高于腺癌及其他病理类型,差别有统计学意义(p=0.000)。2.病理分级:I级组共18例,有效率为77.8%,包括:CR 2例,PR 12例,NC 4例;II级组共42例,有效率为71.4%,包括:CR 3例,PR 27例,NC 8例,PD 4例;III级组共39例,有效率为66.7%,包括:PR 26例,NC 9例,PD 4例。各组患者行NACT治疗后有效率差别无统计学意义(p0.05)。3.临床分期:Ib2期组共22例,有效率72.2%,包括:CR 2例,PR 14例,NC 6例;IIa期组共45例,有效率为73.3%,包括:CR 1例,PR 32例,NC 8例,PD 4例;IIb期组共32例,有效率为65.6%,包括:CR 2例,PR 19例,NC 7例,PD 4例;各组患者经NACT治疗后有效率差别无统计学意义(p0.05)。4.化疗方案:TP组共60例,有效率73.3%,包括:CR 3例,PR 41例,NC 12例,PD 4例;TC组共25例,有效率72.0%,包括:CR 2例,PR 16例,NC 4例,PD 3例;DP组共7例,有效率57.1%,包括:PR 4例,NC 2例,PD 1例;DC组共5例,有效率40%,包括:NC 2例,PD 3例;其他组共2例,有效率50.0%,包括:PR 1例,NC 1例。TP组疗效高于其他组,差异无统计学意义(p0.05)。5.化疗周期:1周期化疗组共48例,有效率58.3%,包括:PR 28例,NC 15例,PD 5例。2周期化疗组共51例,有效率82.4%,包括:CR 5例,PR 37例,NC 6例,PD 3例。比较两组疗效差异,2周期化疗组的疗效高于1周期化疗组,差异有统计学意义(p0.05)。6.宫颈癌组织内血流情况:血流丰富组共56例,有效率76.8%,包括:CR 4例,PR 34例,NC 12例,PD 6例;血流不丰富组共43例,有效率62.8%,包括:CR 1例,PR 23例,NC 15例,PD 4例;血流丰富的宫颈癌患者NACT近期疗效高于血流不丰富的患者,但是疗效无明显差异(p0.05)。结论:1.病理类型:鳞状细胞癌的疗效明显高于其他病理类型,病理类型是影响NACT近期疗效的独立因素;2.病理分级:病理分化程度不同的患者,近期化疗效果差别无统计学意义。病理分级不是影响NACT近期疗效的因素;3.临床分期:临床分期越高,治疗有效率越低,但疗效差异无统计学意义。临床分期不是影响NACT近期疗效的因素;4.化疗方案:以铂类为基础的各化疗方案的有效率无明显差别,化疗方案不是影响新辅助化疗近期疗效的因素;5.化疗疗程:行1周期化疗的患者有效率显著低于2周期化疗者,其差别有统计学意义。建议至少行2周期NACT化疗。6.肿瘤内血流情况:肿瘤组织内血流丰富的患者有效率高于血流不丰富者,但差别无统计学意义。其不是影响新辅助化疗疗效的因素。
[Abstract]:Objective:To investigate the factors influencing the short-term efficacy of neoadjuvant chemotherapy for stage Ib2-IIb cervical cancer.Methods:The clinical data of patients who were admitted to the Second Affiliated Hospital of Dalian Medical University and the Obstetrics and Gynecology Hospital of Dalian Obstetrics and Gynecology Hospital from June 2010 to July 2016 were retrospectively analyzed. Patients were treated with neoadjuvant chemotherapy (NACT). The patients were grouped according to pathological type, pathological grade, clinical stage, chemotherapy regimen, chemotherapy course, blood flow of cervical cancer tissues and other factors. The changes of cervical mass size before and after chemotherapy were compared, and statistics were made according to WHO (World Health Organization) evaluation criteria of solid tumor efficacy. The total number of complete remission, partial remission, unchanged, progressive and other cases were calculated according to the formula (total number of partial remission cases?(10) (28) 100% effective rate). The data were analyzed by multivariate nonlinear binary logistic regression. Results: 1. Pathological type: 85 cases of squamous cell carcinoma, the effective rate was 70.6%, including: complete remission. There were 5 cases of CR, 63 cases of PR, 14 cases of NC and 3 cases of PD, 10 cases of adenocarcinoma, including 1 case of PR, 6 cases of NC and 3 cases of PD, and 4 cases of other groups, the effective rate was 25%, including 1 case of PR, 1 case of NC and 2 cases of PD. The pathological types were adenosquamous carcinoma, papillary squamous carcinoma and neuroendocrine carcinoma. The effect was significantly higher than that of adenocarcinoma and other pathological types, the difference was statistically significant (p = 0.000). 2. Pathological grading: 18 cases in grade I group, the effective rate was 77.8%, including: CR 2 cases, PR 12 cases, NC 4 cases; 42 cases in grade II group, the effective rate was 71.4%, including: CR 3 cases, PR 27 cases, NC 8 cases, PD 4 cases; 39 cases in grade III group, the effective rate was 66.7%, including: PR 26 cases, NC 9 cases, PD. Clinical staging: Ib2 group 22 cases, effective rate 72.2%, including: CR 2 cases, PR 14 cases, NC 6 cases; III group 45 cases, effective rate 73.3%, including: CR 1 case, PR 32 cases, NC 8 cases, PD 4 cases; III group 32 cases, effective rate 65.6%, including: CR 2 cases, PR 19 cases, NC 7 cases, P There was no significant difference in the effective rate among the three groups (p0.05). 4. Chemotherapy regimen: TP group 60 cases, effective rate 73.3%, including: CR 3 cases, PR 41 cases, NC 12 cases, PD 4 cases; TC group 25 cases, effective rate 72.0%, including: CR 2 cases, PR 16 cases, NC 4 cases, PD 3 cases; DP group 7 cases, effective rate 57.1%, including: PR 4 cases, NC2 cases, PD 1 cases; DC group 5.1%. The effective rate was 40%, including 2 cases of NC, 3 cases of PD, 2 cases of other groups, the effective rate was 50.0%, including 1 case of PR, 1 case of NC. The curative effect of TP group was higher than that of other groups, the difference was not statistically significant (p0.05). 5. Chemotherapy cycle: 48 cases in one cycle chemotherapy group, the effective rate was 58.3%, including: PR 28 cases, NC 15 cases, PD 5 cases in 5.2 cycle chemotherapy group, the effective rate was 82.4%, including: CR 5 cases, PR. There were 37 cases, 6 cases of NC and 3 cases of PD. The curative effect of 2-cycle chemotherapy group was higher than that of 1-cycle chemotherapy group, and the difference was statistically significant (p0.05). 6. Blood flow in cervical cancer tissues: 56 cases of rich blood flow group, effective rate 76.8%, including: CR 4 cases, PR 34 cases, NC 12 cases, PD 6 cases; 43 cases of low blood flow group, effective rate 62.8%, including: CR 1 case, P Conclusion: 1. Pathological type: the curative effect of squamous cell carcinoma is significantly higher than other pathological types, pathological type is an independent factor affecting the short-term efficacy of NACT; 2. Pathological classification: pathological differentiation process Pathological grading is not a factor affecting the short-term efficacy of NACT; 3. Clinical staging: the higher the clinical stage, the lower the treatment efficiency, but there is no significant difference in efficacy. Clinical staging is not a factor affecting the short-term efficacy of NACT; 4. Chemotherapy regimen: platinum-based chemotherapy. There was no significant difference in the efficacy of the regimen, and the chemotherapy regimen was not a factor affecting the short-term efficacy of neoadjuvant chemotherapy. 5. Chemotherapy regimen: The effective rate of patients receiving one cycle chemotherapy was significantly lower than that of patients receiving two cycles chemotherapy, the difference was statistically significant. Efficiency was higher than that of patients with insufficient blood flow, but the difference was not statistically significant.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
本文编号：2179901
[Abstract]:Objective:To investigate the factors influencing the short-term efficacy of neoadjuvant chemotherapy for stage Ib2-IIb cervical cancer.Methods:The clinical data of patients who were admitted to the Second Affiliated Hospital of Dalian Medical University and the Obstetrics and Gynecology Hospital of Dalian Obstetrics and Gynecology Hospital from June 2010 to July 2016 were retrospectively analyzed. Patients were treated with neoadjuvant chemotherapy (NACT). The patients were grouped according to pathological type, pathological grade, clinical stage, chemotherapy regimen, chemotherapy course, blood flow of cervical cancer tissues and other factors. The changes of cervical mass size before and after chemotherapy were compared, and statistics were made according to WHO (World Health Organization) evaluation criteria of solid tumor efficacy. The total number of complete remission, partial remission, unchanged, progressive and other cases were calculated according to the formula (total number of partial remission cases?(10) (28) 100% effective rate). The data were analyzed by multivariate nonlinear binary logistic regression. Results: 1. Pathological type: 85 cases of squamous cell carcinoma, the effective rate was 70.6%, including: complete remission. There were 5 cases of CR, 63 cases of PR, 14 cases of NC and 3 cases of PD, 10 cases of adenocarcinoma, including 1 case of PR, 6 cases of NC and 3 cases of PD, and 4 cases of other groups, the effective rate was 25%, including 1 case of PR, 1 case of NC and 2 cases of PD. The pathological types were adenosquamous carcinoma, papillary squamous carcinoma and neuroendocrine carcinoma. The effect was significantly higher than that of adenocarcinoma and other pathological types, the difference was statistically significant (p = 0.000). 2. Pathological grading: 18 cases in grade I group, the effective rate was 77.8%, including: CR 2 cases, PR 12 cases, NC 4 cases; 42 cases in grade II group, the effective rate was 71.4%, including: CR 3 cases, PR 27 cases, NC 8 cases, PD 4 cases; 39 cases in grade III group, the effective rate was 66.7%, including: PR 26 cases, NC 9 cases, PD. Clinical staging: Ib2 group 22 cases, effective rate 72.2%, including: CR 2 cases, PR 14 cases, NC 6 cases; III group 45 cases, effective rate 73.3%, including: CR 1 case, PR 32 cases, NC 8 cases, PD 4 cases; III group 32 cases, effective rate 65.6%, including: CR 2 cases, PR 19 cases, NC 7 cases, P There was no significant difference in the effective rate among the three groups (p0.05). 4. Chemotherapy regimen: TP group 60 cases, effective rate 73.3%, including: CR 3 cases, PR 41 cases, NC 12 cases, PD 4 cases; TC group 25 cases, effective rate 72.0%, including: CR 2 cases, PR 16 cases, NC 4 cases, PD 3 cases; DP group 7 cases, effective rate 57.1%, including: PR 4 cases, NC2 cases, PD 1 cases; DC group 5.1%. The effective rate was 40%, including 2 cases of NC, 3 cases of PD, 2 cases of other groups, the effective rate was 50.0%, including 1 case of PR, 1 case of NC. The curative effect of TP group was higher than that of other groups, the difference was not statistically significant (p0.05). 5. Chemotherapy cycle: 48 cases in one cycle chemotherapy group, the effective rate was 58.3%, including: PR 28 cases, NC 15 cases, PD 5 cases in 5.2 cycle chemotherapy group, the effective rate was 82.4%, including: CR 5 cases, PR. There were 37 cases, 6 cases of NC and 3 cases of PD. The curative effect of 2-cycle chemotherapy group was higher than that of 1-cycle chemotherapy group, and the difference was statistically significant (p0.05). 6. Blood flow in cervical cancer tissues: 56 cases of rich blood flow group, effective rate 76.8%, including: CR 4 cases, PR 34 cases, NC 12 cases, PD 6 cases; 43 cases of low blood flow group, effective rate 62.8%, including: CR 1 case, P Conclusion: 1. Pathological type: the curative effect of squamous cell carcinoma is significantly higher than other pathological types, pathological type is an independent factor affecting the short-term efficacy of NACT; 2. Pathological classification: pathological differentiation process Pathological grading is not a factor affecting the short-term efficacy of NACT; 3. Clinical staging: the higher the clinical stage, the lower the treatment efficiency, but there is no significant difference in efficacy. Clinical staging is not a factor affecting the short-term efficacy of NACT; 4. Chemotherapy regimen: platinum-based chemotherapy. There was no significant difference in the efficacy of the regimen, and the chemotherapy regimen was not a factor affecting the short-term efficacy of neoadjuvant chemotherapy. 5. Chemotherapy regimen: The effective rate of patients receiving one cycle chemotherapy was significantly lower than that of patients receiving two cycles chemotherapy, the difference was statistically significant. Efficiency was higher than that of patients with insufficient blood flow, but the difference was not statistically significant.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33
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