子宫内膜癌的激素辅助治疗临床与循证医学研究

发布时间：2018-02-22 16:25

  本文关键词： 子宫内膜癌 激素辅助治疗 预后 Cox模型 激素辅助治疗 子宫内膜癌 系统评价 随机对照试验 Meta分析　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的观察激素治疗对手术后的子宫内膜癌患者预后的影响,探索激素治疗的可行性。 方法本研究收集了2005年1月到2013年5月在广西医科大学附属肿瘤医院妇瘤科住院的321例高危型子宫内膜癌患者的病历资料,进行回顾性研究。统计学处理：应用SPSS.19.0软件进行统计学分析,对计数资料及率的比较采用X2检验,对子宫内膜癌术后激素治疗疗效的影响因素采用Kaplan-meier生存分析进行单因素分析,Log-rank test检验,P0.05表示差异有统计学意义,对有意义的单因素进行Cox模型多因素分析,多因素分析P0.05认为差异具有统计学意义。 结果影响激素治疗疗效的因素分析：激素使用是否超过1年、孕激素受体(PR)、病理分级、病理分期是影响激素治疗疗效的重要因素(P0.05),多因素分析：孕激素受体(PR)、病理分级、激素使用是否超过1年是影响激素治疗疗效的独立危险因素(P0.05)。激素治疗对于复发率、生存率的影响：激素组的复发率低于对照组,两者比较差异具有显著性(P0.05)；激素组的5年生存率较对照组高,两者比较差异具有显著性(P0.05)；激素组无瘤生存率比对照组高,差异具有显著性(P0.05)。 结论激素治疗作为子宫内膜癌患者综合治疗的一部分,持续应用1年以上,能够改善患者的长期预后,减少复发,增加患者总生存率,术后有高危因素的子宫内膜癌可以考虑使用激素治疗,以改善患者的预后。。 目的系统评价激素治疗对早期子宫内膜癌患者预后的影响,研究激素治疗是否能改善早期高危型子宫内膜癌患者的预后。 方法计算机检索MEDLINE、EMbase、Cochrane图书馆、Pubmed、Ovid数据库、中国知网、维普中文科技期刊数据库、清华同方数据库、万方数据库等,手工检索与子宫内膜癌激素治疗相关的文献,检索截止时间2013年12月,收集子宫内膜癌辅助使用激素治疗的随机对照试验和临床对照试验。由两名研究人员选择独立试验,提取资料,评价纳入资料的方法与质量,并提取数据进行Meta分析。 结果最终纳入符合条件的RCTs共6个,包括6篇文献和4440例患者,对入选研究的治疗组与对照组的总体复发率、总体生存率、无瘤生存率的比较,进行统计学分析与比较。Meta分析结果显示：治疗组与对照组的复发率、总生存率、无瘤生存率比较(P0.05),差异没有统计学显著性,手术+激素治疗组比较单纯手术组对于患者的复发率、总生存率、无瘤生存率没有明显影响,不能改善早期子宫内膜癌的预后。对高危型子宫内膜癌激素治疗疗效的分析,手术+激素治疗组与单纯手术组复发率及无瘤生存率比较有统计学差异(P0.05),总生存率差异没有统计学意义(P0.05),手术+激素治疗组复发率较单纯手术组低,无瘤生存率较单纯手术组高,激素治疗可以改善患者的复发率及无瘤生存率,但对总生存率没有明显影响。 结论目前尚不能认为术后应用激素治疗能够改善早期子宫内膜癌的预后。但激素治疗对于改善早期高危型子宫内膜癌的预后有一定的作用。
[Abstract]:Objective To observe the effect of hormone therapy on the prognosis of patients with endometrial carcinoma after operation, and to explore the feasibility of hormone therapy.
Methods this study collected from January 2005 to May 2013 in the Department of Gynecology Hospital Affiliated Tumor Hospital of Guangxi Medical University 321 patients with high-risk endometrial cancer clinical data were retrospectively analyzed. Statistical analysis: SPSS.19.0 software was used for statistical analysis of count data, and compared with the rate of X2 test, Kaplan-meier survival analysis was used for single factor analysis the influence factors of hormone therapy in endometrial carcinoma after operation, Log-rank test test, P0.05 said the difference was statistically significant, the single factor meaningful Cox model multivariate analysis, multivariate analysis P0.05 considered statistically significant difference.
Analysis of factors affecting the outcome of hormone therapy: hormone use is more than 1 years, progesterone receptor (PR), pathological grade, pathological stage is an important factor affecting hormone therapy (P0.05), multivariate analysis: progesterone receptor (PR), pathological grade, hormone use is more than 1 years were independent risk factors affecting hormone the curative effect of hormone therapy (P0.05). The recurrence rate, affecting the survival rate: the treatment group the recurrence rate was lower than the control group, the difference was statistically significant (P0.05); treatment group 5 years survival rate is higher than the control group, the difference was statistically significant (P0.05); group hormone free survival the rate is higher than the control group, the difference was significant (P0.05).
Conclusion hormone therapy as part of a comprehensive treatment of patients with endometrial cancer, continuous use of more than 1 years, the long-term prognosis of patients can be improved by reducing the recurrence of patients, increase the total survival rate, postoperative endometrial cancer risk factors can be considered using hormone therapy to improve the prognosis of patients.
Objective to systematically evaluate the effect of hormone therapy on the prognosis of patients with early endometrial cancer, and to study whether hormone therapy can improve the prognosis of early high-risk endometrial cancer.
Methods we searched MEDLINE, EMbase, Cochrane library, Pubmed, Ovid database, Chinese HowNet, Chinese VIP periodical database, Tsinghua Tongfang database, Wanfang database, and endometrial cancer associated with hormone therapy literature manual retrieval, retrieval deadline December 2013, randomized controlled trials and controlled clinical trials to collect endometrial cancer adjuvant use hormone therapy. By two researchers independently test, data extraction and quality assessment into data and data extraction method, Meta analysis was carried out.
缁撴灉鏈，

本文编号：1524792