77例上皮性卵巢癌预后相关因素分析

发布时间：2018-01-08 07:02

本文关键词：77例上皮性卵巢癌预后相关因素分析　出处：《河北医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察PR、FOXM1、ERα和ERβ在上皮性卵巢癌的表达情况,探讨上皮性卵巢癌患者的发病年龄、术后辅助化疗、病理组织类型、FIGO分期、淋巴结和阑尾转移、手术残留病灶的大小及PR、FOXM1、ERα和ERβ的表达等因素对预后的影响。方法:免疫组织化学方法检测77例人卵巢癌组织中PR、FOXM1、ERα和ERβ的表达情况。通过门诊及电话随访,了解患者出院后的诊治及生存情况。回顾性分析患者的发病年龄、术后辅助化疗、病理组织类型、FIGO分期、淋巴结和阑尾是否转移、手术残留病灶的大小及PR、FOXM1、ERα和ERβ的表达等因素对患者预后的影响。应用SPSS 13.0软件进行统计学处理,采用Kaplan-Meier法进行单因素分析,应用Log-rank法对生存率差异进行检验(P0.05);Cox回归模型进行多因素分析(P0.05)。结果:1 77例上皮性卵巢癌患者中,发病年龄50岁组患者平均生存时间67.875个月,95%CI[53.239,82.510];≥50岁组患者平均生存时间43.895个月,95%CI[34.297,53.492],两组患者的生存率差异有统计学意义(P=0.008)。术后辅助化疗0次患者的平均生存时间为29.314个月,95%CI[18.425,40.202];6次化疗的患者平均生存时间为41.949个月,95%CI[33.532,50.366];≥6次化疗的患者平均生存时间为69.937个月,95%CI[55.436,84.437],三组患者的生存率差异有统计学意义(P=0.001)。低级别浆液性卵巢癌患者的平均生存时间92.644个月,95%CI[63.658,121.630];高级别浆液性卵巢癌患者的平均生存时间47.044个月,95%CI[39.398,54.690];粘液性卵巢癌患者的平均生存时间49.000个月,95%CI[8.074,89.926];子宫内膜样卵巢癌患者的平均生存时间43.900个月,95%CI[34.626,53.174];透明细胞卵巢癌患者的平均生存时间17.600个月,95%CI[13.429,21.771],五组不同病理组织类型的卵巢癌患者的生存率差异有统计学意义(P=0.001)。Ⅰ期卵巢癌患者的平均生存时间67.800个月,95%CI[40.653,94.947];Ⅱ期卵巢癌患者的平均生存时间16.000个月,95%CI[2.579,29.421];Ⅲ期卵巢癌患者的平均生存时间55.660个月,95%CI[45.408,65.912];Ⅳ期卵巢癌患者的平均生存时间29.778个月,95%CI[17.301,42.255],四组不同FIGO分期的卵巢癌患者的生存率差异有统计学意义(P=0.004)。淋巴结未转移组的平均生存时间66.339个月,95%CI[52.747,79.931];淋巴结转移组的平均生存时间40.134个月,95%CI[30.220,50.049],两组患者的生存率差异有统计学意义(P=0.003)。阑尾未转移组的平均生存时间59.585个月,95%CI[47.477,71.694];阑尾转移组的平均生存时间38.950个月,95%CI[31.574,46.327],两组患者的生存率差异有统计学意义(P=0.032)。肿瘤细胞减灭术中残留灶1cm组平均生存时间66.723个月,95%CI[55.234,78.203];术中残留灶≥1cm组平均生存时间30.004个月,95%CI[22.418,37.590],两组患者的生存率差异有统计学意义(P=0.001)。2 77例卵巢癌石蜡标本中,PR阴性表达68例(88.31%),阳性表达9例(11.69%);FOXM1阴性表达17例(22.08%),阳性表达60例(77.92%);ERα阴性表达42例(54.55%),阳性表达35例(45.45%);ERβ阴性表达20例(25.97%),阳性表达57例(74.03%)。PR阴性表达组平均生存时间48.971个月,95%CI[40.235,57.707];阳性表达组平均生存时间78.639个月,95%CI[52.192,105.086],两组患者的生存率差异有统计学意义(P=0.046)。FOXM1阴性表达组平均生存时间38.208个月,95%CI[23.607,52.809];阳性表达组平均生存时间54.128个月,95%CI[44.570,63.686],两组患者的生存率差异没有统计学意义(P=0.474)。ERα阴性表达组平均生存时间49.493个月,95%CI[38.419,60.568];阳性表达组平均生存时间56.447个月,95%CI[42.290,70.603],两组患者的生存率差异没有统计学意义(P=0.597)。ERβ阴性表达组平均生存时间38.126个月,95%CI[27.901,48.352];阳性表达组平均生存时间58.208个月,95%CI[47.027,69.390],两组患者的生存率差异有统计学意义(P=0.043)。3多因素分析结果显示上皮性卵巢癌的化疗疗程、淋巴结是否转移、残留灶的大小、ERβ的阳性表达是影响上皮性卵巢癌预后的独立危险因素。结论:上皮性卵巢癌患者的发病年龄、术后辅助化疗疗程、病理组织类型、FIGO分期、淋巴结和阑尾转移、残留灶的大小及PR和ERβ的表达情况等因素与其预后密切相关。FOXM1和ERα的表达情况对上皮性卵巢癌的预后没有影响。理想的肿瘤减灭术后,辅助规律的化疗可显著改善上皮性卵巢癌患者的预后;ERβ可作为其预后的标记物。
[Abstract]:Objective: To observe the effect of PR, FOXM1, ER alpha and ER beta expression in epithelial ovarian cancer, to investigate the age of onset in patients with epithelial ovarian cancer, adjuvant chemotherapy, pathological type, FIGO staging, lymph node metastasis and the appendix surgery, residual size and PR, the lesions of FOXM1, ER alpha and ER the expression of beta and other factors on the prognosis. Methods: immunohistochemical method in 77 cases of human ovarian carcinoma PR, FOXM1 expression of ER alpha and ER beta. Through outpatient and telephone follow-up, understand the patients discharged from hospital after treatment and survival were retrospectively analyzed. The age of patients, postoperative adjuvant chemotherapy pathological type, FIGO staging, lymph node metastasis, and the appendix, the residual operation size and PR, the lesions of FOXM1, ER alpha and ER beta expression and other factors on the prognosis of the patients. The application of SPSS 13 software was used for statistical analysis, single factor analysis using the Kaplan-Meier method, should be To test the difference of survival rate by Log-rank method (P0.05); Cox regression model for multivariate analysis (P0.05). Results: 177 cases of epithelial ovarian cancer patients, age 50 years old group the mean survival time were 67.875 months, 95%CI[53.239,82.510] group of patients over 50 years old; average survival time was 43.895 months, 95%CI[34.297,53.492], statistically significant difference in survival rate between the two groups (P=0.008). Postoperative adjuvant chemotherapy in 0 patients with an average survival time of 29.314 months, 6 times of chemotherapy for patients with 95%CI[18.425,40.202]; the average survival time was 41.949 months, 95%CI[33.532,50.366] = 6; chemotherapy of patients with an average survival time was 69.937 months, 95%CI[55.436,84.437]. There is significant difference in survival rate between the three groups (P=0.001). The average survival time of low grade serous ovarian cancer patients for 92.644 months, 95%CI[63.658121.630]; high-grade serous egg The average survival time of ovarian cancer patients for 47.044 months, 95%CI[39.398,54.690]; the average survival time of mucinous ovarian cancer patients for 49 months, 95%CI[8.074,89.926]; the average survival time of endometrioid ovarian cancer patients for 43.900 months, 95%CI[34.626,53.174]; the average survival time of patients with clear cell ovarian cancer 17.600 months, 95%CI[13.429,21.771], there was statistical significance in ovarian cancer the survival rate of patients between the five groups of different pathological types (P=0.001). The average survival time of patients with ovarian cancer of stage 67.800 months, 95%CI[40.653,94.947]; the average survival time of patients with ovarian cancer stage 95%CI[2.579,29.421]; 16 months, the average survival time of patients with ovarian cancer stage III 55.660 months, the average survival time of 95%CI[45.408,65.912]; ovarian cancer patients with stage 95%CI[17.301,42.255], 29.778 months, four groups of different FIGO stage ovarian cancer patients The survival rate was statistically significant (P=0.004). The average survival time of the group without lymph node metastasis 66.339 months, 95%CI[52.747,79.931]; lymph node metastasis group the average survival time of 40.134 months, 95%CI[30.220,50.049] was statistically significant difference in survival rate between the two groups (P=0.003). The average survival time of appendectomy without metastasis group 59.585 July, 95%CI[47.477,71.694]; the average survival time of 38.950 months appendiceal metastasis group, 95%CI[31.574,46.327], was statistically significant difference in survival rate between the two groups (P=0.032). Cytoreductive surgery residual tumor 1cm group mean survival time of 66.723 months, 95%CI[55.234,78.203] = 1cm; tumor group average survival time of 30.004 months, the residual operation in 95%CI[22.418,37.590], there is significant difference in survival rate between the two groups (P=0.001.2) in 77 cases of ovarian carcinoma were PR negative expression in 68 cases (88.31%), positive list In 9 cases (11.69%); the negative expression of FOXM1 in 17 cases (22.08%), 60 cases (77.92%); the positive expression of ER alpha negative expression in 42 cases (54.55%), 35 cases (45.45%); the positive expression of ER beta expression was negative in 20 cases (25.97%), 57 cases were positive (74.03%) in.PR negative expression group average the survival time of 48.971 months, 95%CI[40.235,57.707] positive expression group; the average survival time of 78.639 months, 95%CI[52.192105.086] was statistically significant difference in survival rate between the two groups (P=0.046).FOXM1 negative expression group the average survival time of 38.208 months, 95%CI[23.607,52.809] positive expression group; the average survival time was 54.128 months, 95%CI[44.570,63.686], the survival rate between the two groups there was no statistical significance (P=0.474).ER alpha negative expression group the average survival time of 49.493 months, 95%CI[38.419,60.568] positive expression group; the average survival time was 56.447 months, 95%CI[42.290,70.603], the survival rate between the two groups There was no statistical significance (P=0.597).ER beta negative expression group average survival time of 38.126 months, 95%CI[27.901,48.352]; positive group average survival time was 58.208 months, 95%CI[47.027,69.390] was statistically significant difference in survival rate between the two groups (P=0.043).3 multivariate analysis showed that chemotherapy of epithelial ovarian cancer, lymph node metastasis. Residual tumor size, the expression of ER beta were independent prognostic factors of epithelial ovarian carcinoma. Conclusion: the age of onset in patients with epithelial ovarian cancer, adjuvant chemotherapy in the postoperative course, pathology type, FIGO staging, lymph node metastasis and the appendix, did not affect the expression of residual tumor size and PR and the expression of ER beta and other factors related to the prognosis of.FOXM1 and ER alpha on the prognosis of epithelial ovarian carcinoma. The ideal cytoreductive surgery and chemotherapy can significantly improve on the auxiliary rules The prognosis of patients with ovarian ovarian cancer; ER beta can be used as a marker for its prognosis.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.31

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