早期宫颈腺癌的预后分析

发布时间：2018-01-26 11:45

本文关键词： 早期宫颈腺癌术后预后分析　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:宫颈癌在世界范围内是除乳腺癌外导致女性发病和死亡最常见的恶性肿瘤,也是发病率最高的女性生殖系统恶性肿瘤。在发展中国家中,宫颈癌约占女性恶性肿瘤的24%,严重威胁妇女的健康、生命和生活质量。宫颈癌常见的病理类型有宫颈鳞癌、宫颈腺癌和腺鳞癌三种类型,其中宫颈腺癌的发病率近年来逐渐升高,且更趋向于年轻化。宫颈腺癌与宫颈鳞癌相比表现出不同的生物学特性,如宫颈腺癌较宫颈鳞癌发病隐匿,临床表现及妇科检查各异,术前易误诊、漏诊,易影响诊断和治疗方法的选择,且宫颈腺癌对放疗不如宫颈鳞癌敏感,预后较差。虽然目前许多研究者正在致力研究与宫颈腺癌预后有关的因素,但宫颈腺癌确切的预后因素尚未明确。因此研究宫颈腺癌的预后相关因素,从而指导临床治疗是非常有意义的。研究目的:研究早期宫颈腺癌(I B1-II A期)经手术治疗后患者的预后相关因素。研究方法:对我院2005年1月1日至2015年1月1日初治的80例早期宫颈腺癌患者(FIGO分期IB1期-IIA期)进行回顾性分析,该80例患者均行根治性子宫切除+双附件切除+盆腔淋巴结清扫术,收集所有患者的临床资料,包括人口学资料、临床资料及随访信息等,观察和记录患者的无瘤生存期(disease-free survival,DFS)与总生存期(overall survival,OS)。对年龄、肿瘤分期、分化程度、肿瘤直径、绝经、淋巴结转移、间质浸润深度、LVSI、肿瘤标志物、累及附件、术前是否新辅助化疗、术后是否行放化疗、P16等因素进行统计分析,采用Kaplan-Meier法计算生存率,Log-rank检验进行单因素分析及各组生存率曲线分布比较,Cox回归模型进行多因素分析,研究影响宫颈腺癌预后的因素。结果:回访的80例早期宫颈腺癌患者发病最小年龄为29岁,最大发病年龄73岁,平均年龄为45.6岁,其中40-49岁的患者发病率最高,80例患者的生存时间为8-124个月,中位生存时间50个月,因宫颈腺癌死亡者10例(12.5%)。所回访患者的3年生存率为90.5%,5年生存率为87.1%。单因素分析显示:年龄、绝经、临床分期、肿瘤直径、分化程度、淋巴结转移、间质浸润深度的生存率差异有统计学意义(P0.05)。Cox风险比例回归模型对年龄、临床分期、绝经与否、分化程度、肿瘤直径、间质浸润深度、淋巴结转移等因素进行多因素分析,结果显示:间质浸润深度、分化程度、绝经是影响宫颈腺癌预后的独立因素。结论:间质浸润深度、分化程度、绝经与否是影响早期宫颈腺癌术后预后的独立因素。
[Abstract]:Background: cervical cancer is the most common malignant tumor in women except breast cancer, and it is also the most common malignant tumor in female reproductive system. Cervical cancer accounts for about 24% of female malignant tumors, which seriously threaten women's health, life and quality of life. The common pathological types of cervical cancer include cervical squamous cell carcinoma, cervical adenocarcinoma and adenosquamous carcinoma. The incidence of cervical adenocarcinoma gradually increased in recent years, and tend to be younger. Compared with cervical squamous cell carcinoma, cervical adenocarcinoma has different biological characteristics, such as cervical adenocarcinoma than cervical squamous cell carcinoma. The clinical manifestation and gynecological examination are different, preoperatively misdiagnosed, missed diagnosis, easy to affect the choice of diagnosis and treatment, and cervical adenocarcinoma is less sensitive to radiotherapy than cervical squamous cell carcinoma. Although many researchers are studying the factors related to the prognosis of cervical adenocarcinoma, the exact prognostic factors of cervical adenocarcinoma are not clear. Therefore, the prognostic factors of cervical adenocarcinoma are studied. Therefore, it is very meaningful to guide clinical treatment. Objective: to study the early stage I B 1-II A of cervical adenocarcinoma. Prognostic factors of patients undergoing surgical treatment. Methods: 80 cases of early cervical adenocarcinoma treated in our hospital from January 1st 2005 to January 1st 2015 were studied. FIGO stage: IB1 phase-IIA stage) were retrospectively analyzed. All the 80 patients underwent radical hysterectomy and double appendage resection of pelvic lymph node dissection. All the clinical data including demographic data clinical data and follow-up information were collected. The tumor-free survival time (DFSs) and total survival time (survival) of the patients were observed and recorded. For age, tumor staging, differentiation, tumor diameter, menopause, lymph node metastasis, interstitial infiltration depth of LVSIs, tumor markers, attachment, preoperative neoadjuvant chemotherapy. The survival rate was calculated by Kaplan-Meier method. Log-rank test was performed by univariate analysis and comparison of survival curve distribution among groups. Multivariate analysis was performed by Cox regression model. Results: the minimum age of 80 patients with early cervical adenocarcinoma was 29 years old and the maximum age was 73 years with an average age of 45.6 years. The survival time of 80 patients aged 40-49 years was 8-124 months, and the median survival time was 50 months. The 3-year survival rate was 90.5 and the 5-year survival rate was 87.1. Univariate analysis showed: age, menopause, clinical stage. The survival rates of tumor diameter, differentiation degree, lymph node metastasis, and depth of interstitial infiltration were significantly different from those of age, clinical stage, menopause or not. The degree of differentiation, the diameter of tumor, the depth of interstitial infiltration, lymph node metastasis and other factors were analyzed. The results showed that the depth of interstitial infiltration, the degree of differentiation. Conclusion: the depth of interstitial infiltration, the degree of differentiation and the menopause are independent factors influencing the prognosis of early cervical adenocarcinoma.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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