宫颈癌治疗后随访方案的选择及CTHRC1与宫颈癌预后的关系

发布时间：2018-03-17 08:52

本文选题：宫颈癌　切入点：HPV　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:宫颈癌是常见的妇科恶性肿瘤之一,其严重威胁女性的健康与生命。近年来,随着宫颈癌筛查及诊断技术的发展,手术操作方法的改进,越来越多的宫颈癌患者及时获得诊治。但在进行了规范化治疗后,仍然有部分宫颈癌患者出现复发,而这是导致宫颈癌患者死亡的主要原因。因此,如何早期发现并有效预测宫颈癌复发及评估其预后,延长宫颈癌患者的生存时间,成为众多临床医生关注的问题。宫颈癌治疗后定期的临床随访有助于早期发现宫颈癌复发,提高宫颈癌患者生存率。但是,宫颈癌治疗后随访的具体方案尚未有定论。液基细胞学(liquid-based thinprep cytology test,TCT)检测、人乳头瘤病毒(human papillomavirus,HPV)检测、鳞状细胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)检测等方法均常用于宫颈癌治疗后的随访中,但均具有局限性,导致一部分的宫颈癌复发患者被漏诊,而HPV、TCT以及SCC-Ag三者联合检测应用于宫颈癌治疗后的随访中,能否提高宫颈癌复发患者的检出率,目前尚未见相关文献报道。此外,评估宫颈癌患者的预后并有效预测其复发,对提高其生存率同样具有重要意义。近年来研究表示,恶性肿瘤的发生发展、侵袭转移及预后都与肿瘤微环境密切关联,二者既相互依存又相互制约,而胶原三股螺旋重复蛋白 1(Collagen triple helix repeat containing-1,CTHRC1)作为肿瘤微环境的重要成分之一,其在肿瘤中的作用也越来越被重视。近年来,异常表达的CTHRC1在多种实体肿瘤中被发现,并且在肺癌、结直肠癌、胃癌、卵巢癌等恶性肿瘤的侵袭转移过程中起重要作用,并是独立生存预后影响因素。此外,研究表明,CTHRC1在宫颈疾病的发生发展过程中的表达呈现上升趋势,但尚未有关于CTHRC1与宫颈癌复发及预后关系的深入研究。第一章HPV、TCT及SCC联合检测在宫颈癌治疗后随访中的意义研究目的:探讨HPV、TCT、SCC三者联合检测在宫颈癌治疗后随访中的临床价值。研究方法:通过对205例宫颈癌治疗后患者数据进行分析,将HPV、TCT、SCC三者联合检测与HPV、TCT、SCC三者单独检测、TCT联合HPV检测等宫颈癌治疗后的随访方案进行比较,寻找最佳的随访策略。研究结果:1.TCT、HPV及SCC联合检测时对宫颈癌治疗后复发监测的灵敏度及阴性预测值明显高于其他四种检测方案(TCT、HPV、SCC、TCT联合HPV检测)。2.TCT、HPV联合SCC检测对于远处转移及局部复发检测的灵敏度均高,且两者间差异不具有统计学意义(P=0.643)。结论:1.TCT、HPV、SCC-Ag三者联合检测在监测宫颈癌治疗后的复发时,较TCT、HPV、SCC-Ag单独检测及TCT联合HPV检测等方案具有更高的灵敏度及阴性预测值,能够更为敏感地提示宫颈癌复发。2.TCT、HPV、SCC-Ag三者联合检测对于宫颈癌治疗后出现远处转移及局部复发的患者的检出均有较高的灵敏度。第二章CTHRC1在宫颈癌中的表达及其与预后的关系研究目的:检测CTHRC1在宫颈癌组织中的表达,探讨其与宫颈癌复发及预后的关系。研究方法:检测96例宫颈癌患者、28例CIN患者及30例正常宫颈患者的宫颈组织中CTHRC1的表达情况,分析CTHRC1的表达与宫颈癌复发及预后的关系。研究结果:1.CTHRC1在宫颈癌组织中的表达明显高于正常宫颈组织及宫颈上皮内瘤变组织,宫颈上皮内瘤变组织中CTHRC1的表达亦高于正常宫颈组织。2.在复发的宫颈癌组织中,CTHRC1的表达明显高于未复发者。3.在复发性宫颈癌中,复发后宫颈癌组织中CTHRC1的表达高于复发前。4.在不同年龄、组织学类型及肿瘤大小的宫颈癌患者中,CTHRC1的表达之间的差异不具有统计学意义(P0.05)。但是,CTHRC1的表达与宫颈癌患者的临床分期、组织分化程度及淋巴结是否转移相关(P0.05)。5.CTHRC1阴性表达组的无病生存时间及总生存时间均明显长于阳性表达组,其差异具有显著性。6.CTHRC1的表达及淋巴结转移是宫颈癌患者无病生存预后的影响因子,而CTHRC1表达、淋巴结转移、临床分期、组织分化程度及肿瘤大小均为宫颈癌患者总生存预后的影响因子;此外,CTHRC1表达与淋巴结转移、临床分期及组织分化程度,均为宫颈癌患者总生存的独立预后因素(P0.05)。结论:1.CTHRC1在宫颈癌组织中的表达比正常宫颈组织、CIN组织表达高;2.CTHRC1的表达可能与宫颈癌的复发相关;3.CTHRC1的表达与宫颈癌患者的临床分期、组织分化程度及淋巴结是否转移等临床病理因素相关;4.CTHRC1的表达与宫颈癌的预后相关,并是宫颈癌患者总生存的独立预后因子。
[Abstract]:Background: cervical cancer is one of the most common gynecologic malignant tumor, a serious threat to the health and life of women. In recent years, with the rapid development of cervical cancer screening and diagnosis, improvement of surgical operation method, more and more patients to receive timely diagnosis and treatment of cervical cancer. But in the standardization of treatment, there are still some cervical cancer recurrence, which is the leading cause of death in patients with cervical cancer. Therefore, how to effectively forecast and early detection of cervical cancer recurrence and evaluate the prognosis of patients with cervical cancer, prolong the survival time, as many clinicians concern. Clinical follow-up regularly after the treatment of cervical cancer is helpful in the early diagnosis of cervix cancer recurrence, improve cervical cancer survival. However, the specific scheme of cervical cancer after treatment follow-up has not yet been finalized. The liquid based cytology (liquid-based ThinPrep cytology test, TCT) detection, people Papillomavirus (human papillomavirus, HPV) detection of squamous cell carcinoma antigen (squamous cell carcinoma antigen, SCC-Ag) detection methods are often used for the treatment of cervical cancer after follow-up, but all have limitations, resulting in the recurrence of cervical cancer patients was a part of the missed diagnosis, while HPV, TCT and SCC-Ag three combined used in the treatment of cervical cancer after follow-up, can improve the detection rate of patients with cervical cancer recurrence, there are no reports. In addition, evaluate the prognosis of patients with cervical cancer and predict the recurrence and to improve the survival rate also has an important significance in recent years. Research shows that the development of malignant tumor invasion. Metastasis and prognosis are closely related with the tumor microenvironment, the two interdependence and mutual restriction, and three collagen helix repeat protein 1 (Collagen triple helix repeat containing-1, CTHRC1) as a tumor One of the important components of the environment, its role in tumor has been paid more and more attention. In recent years, the abnormal expression of CTHRC1 was found in a variety of solid tumors, and lung cancer, colorectal cancer, gastric cancer, ovarian cancer and other malignant tumor invasion plays an important role in metastasis, and survival are independent prognostic factors. In addition, the research showed that the expression of CTHRC1 in the occurrence and development of cervical disease in the rise, but not deeply study on the relationship between the recurrence and prognosis of cervical cancer and CTHRC1 HPV. In the first chapter, the purpose and significance of TCT SCC detection in the follow-up of cervical cancer after treatment: To investigate the effect of HPV, TCT, clinical value the combined detection of SCC three in the follow-up after treatment of cervical cancer. Methods: the data of 205 cases of patients with cervical cancer after treatment of HPV, TCT, SCC combined detection of the three and HPV, TCT, SCC three test alone, TCT Compare the follow-up program combined with HPV detection of cervical cancer after treatment, to find the optimal follow-up strategy. Results: 1.TCT, HPV and SCC combined detection of sensitivity and negative predictive value of cervical cancer recurrence after treatment was significantly higher than that of the other four detection schemes (TCT, HPV, SCC, TCT and HPV combined detection).2.TCT HPV, SCC combined detection high sensitivity for detection of distant metastasis and local recurrence, and the difference was not statistically significant (P=0.643). Conclusion: 1.TCT, HPV, combined detection of SCC-Ag three in the monitoring of cervical cancer relapse after treatment, compared with TCT, HPV, SCC-Ag and TCT combined with single detection of HPV detection scheme has higher sensitivity and negative predictive value is more sensitive to prompt the recurrence of cervical cancer.2.TCT, HPV combined detection of SCC-Ag three for treatment of cervical cancer after detection of distant metastasis and local recurrence were higher in patients Objective to study the expression of sensitivity. The relationship between the second chapter CTHRC1 in cervical cancer and its prognosis: to detect the expression of CTHRC1 in cervical cancer tissues, and explore their relationship with prognosis and recurrence of cervical cancer. Methods: to detect 96 cases of cervical cancer, the expression of CTHRC1 in cervical tissue of 28 CIN patients and 30 cases of normal cervical patients in the analysis of the relationship between the expression of CTHRC1 and cervical cancer recurrence and prognosis. Results: the expression of 1.CTHRC1 in cervical cancer tissues was significantly higher than that in normal cervical tissues and cervical intraepithelial neoplasia, the expression of cervical intraepithelial neoplasia in CTHRC1 were higher than that of normal cervical tissue.2. in recurrence of cervical cancer tissue, the expression of CTHRC1 was significantly higher than that in non recurrent.3. in recurrent cervical cancer, the expression of CTHRC1 recurrence of cervical carcinoma tissues was higher than that before relapse.4. in different age, histological type and tumor size The cervical cancer patients, the difference between the expression of CTHRC1 was not statistically significant (P0.05). However, patients with stage CTHRC1 cervical cancer expression and clinical, histological differentiation and lymph node metastasis related (P0.05).5.CTHRC1 negative expression group of disease-free survival and overall survival were significantly longer than the positive group expression and lymph node, the difference was significant.6.CTHRC1 transfer is the influence factor of cervical cancer patients with disease-free survival prognosis, but the expression of CTHRC1, lymph node metastasis, clinical stage, histological differentiation and tumor size were overall survival in patients with cervical cancer prognostic factors; in addition, the expression of CTHRC1 and lymph node metastasis, clinical staging and histological differentiation, were independent prognostic factors for overall survival of patients with cervical cancer (P0.05). Conclusion: the expression of 1.CTHRC1 in cervical cancer tissue than in normal cervical tissue, high expression of CIN; 2 The expression of.CTHRC1 may be related with cervical cancer recurrence; staging of patients with cervical cancer clinical 3.CTHRC1 expression, histological differentiation and lymph node metastasis and clinical pathological factors; 4.CTHRC1 expression and prognosis of cervical cancer, and is an independent prognostic factor for overall survival of patients with cervical cancer.

【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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