中国宫颈微偏腺癌临床及病理特征的Meta分析

发布时间：2018-04-11 23:33

本文选题：宫颈肿瘤 + 微偏腺癌　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：利用Meta分析方法，对国内宫颈微偏腺癌患者临床及病理资料进行定量综合分析，以探讨宫颈微偏腺癌独特的临床及病理特征，为该疾病诊断及治疗提供循证医学证据。方法：以宫颈微偏腺癌、宫颈恶性腺瘤及宫颈低离正性腺癌为检索词，检索中国期刊网全文数据库、万方数据库、中国生物医学文献数据库及维普中文科技期刊数据库中1980-2014.1期间公开发表的关于宫颈微偏腺癌的临床病例系列报道，并结合大连市妇产医院诊治的2例宫颈微偏腺癌；依照纳入与排除标准进行文献筛选，定性评价最终纳入文献；提取文献相关数据，并按各研究结局分别录入StataSE.11及SPSS17.0统计学软件中，处理数据以进行Meta分析。结局指标中年龄采用均数、中位数为总效应量；二分类变量采用集合比值比（POR）为总效应量进行评估；区间估计均采用95%可信区间；生存分析应用Kaplan-Meier法。结果： 1.宫颈微偏腺癌临床特点： (1)本研究最终共纳入223例宫颈微偏腺癌患者临床资料。 (2)发病年龄：20-86岁，平均年龄45.44岁，中位数年龄45岁。 (3)临床症状：阴道大量排液约占报道病例65.92%（147/223，95%CI[59.70，72.14]）；阴道不规则流血或以接触性出血为主约占报道病例56.95%（127/223，95%CI[50.45，63.44]）；下腹痛及下腹胀约占报道病例12.56%（28/223，95%CI[8.21，16.91]）。 (4)妇科检查：最常见宫颈肥大、呈桶状，，约占报道病例62.43%（118/189，95%CI[55.53，69.34]）；且大多数宫颈质硬，占报道病例29.63%（56/189，95%CI[23.12，36.14]）；其次为宫颈糜烂占报道病例42.33%（80/189，95%CI[35.28，49.37]）；宫颈呈结节状、表面凹凸不平约占报道病例24.39%（46/189，95%CI[18.22，30.46]）；部分患者宫颈光滑，未见异常，占报道病例13.76%（26/189，95%CI[8.85，18.67]）。 2.宫颈微偏腺癌影像学检查：63例超声检查情况：宫颈回声异常、宫腔积液24例；宫颈部增大19例；无明显异常8例；宫颈占位性病变7例；宫颈多发囊性改变5例。 3.宫颈微偏腺癌细胞学检查：宫颈细胞学筛查阳性率8.51%（8/94），大部分患者需经多次（2-4次）细胞学筛查方可发现阳性。 4.宫颈微偏腺癌病理组织学检查：通过宫颈活检、宫颈锥切确诊为宫颈微偏腺癌者约占报道病例61.11%（99/162，95%CI[53.60，68.62]）。免疫组化检查结果：CEA阳性率93.58%（102/109，95%CI[88.98，98.18]）；P53阳性率75.00%（42/56，95%CI[63.66，86.34]）；Ki-67阳性率100%（41/41）；ER阳性率0%（0/34）；CA125阳性率10.34%（3/29，95%CI[0.00，21.43]）。 5.宫颈微偏腺癌治疗方式：手术治疗为主，术后辅助放、化疗；早期确诊、临床分期及手术方法，对患者预后尤为重要。结论：宫颈微偏腺癌临床症状、体征不明显，诊断较困难，且易漏诊及误诊。细胞学筛查阳性率低，最终确诊依据病理组织学检查。重复且深层宫颈活检或宫颈锥形切病理，并联合免疫组化可提高该病诊断准确率。术前已明确诊断者，应依据疾病临床分期，指导选择个体化治疗方案。
[Abstract]:Objective : To analyze the clinical and pathological data of cervical micro - thyroid cancer patients by Meta - analysis , so as to investigate the unique clinical and pathological characteristics of cervical microdysplasia and provide evidence for evidence - based medicine for the diagnosis and treatment of the disease .

Methods : From 1980 to 2014 , the clinical case series of cervical microdysplasia was published in the database of Chinese Journal Net , Wanfang database , Chinese Biomedical Literature Database and Vpu Chinese Journal of Science and Technology .
Literature screening is conducted according to the inclusion and exclusion criteria , and the qualitative evaluation is finally included in the literature ;
Literature - related data was extracted , and the data was recorded in StataSE . 11 and SPSS 17.0 statistics software respectively according to the results of each study . The data was processed for Meta - analysis . The median age in the outcome measure was the mean number and the median is the total effective amount ;
The second classification variables are evaluated by the aggregate ratio ( PORs ) as the total effective amount ;
The interval estimate is 95 % confidence interval ;
Kaplan - Meier method was applied to survival analysis .

Results :

1 . Clinical characteristics of cervical micro - thyroid carcinoma :

( 1 ) The clinical data of 223 cases of cervical microdysplasia were enrolled in this study .

( 2 ) Age : 20 - 86 years , mean age 45.44 years , median age 45 years .

( 3 ) Clinical symptoms : about 65.92 % ( 147 / 223 , 95 % CI : 59.70 , 72.14 ) ;
vaginal irregular bleeding or contact bleeding accounted for 56.95 % of the reported cases ( 127 / 223 , 95 % CI : 50.45 , 63.44 ) ;
The lower abdominal pain and lower abdominal distension account for 12.56 % of the reported cases ( 28 / 223 , 95 % CI : 8.21 , 16.91 ) .

( 4 ) gynecological examination : the most common cervical hypertrophy , barrel - shaped , accounting for 62.43 % ( 118 / 189 , 95 % CI : 55.53 , 69.34 % ) ;
Most of the cases were hard , accounting for 29.63 % ( 56 / 189 , 95 % CI : 23.12 , 36.14 ) ;
Secondly , cervical erosion accounted for 42.33 % of the reported cases ( 80 / 189 , 95 % CI : 35.28 , 49.37 % ) ;
The cervix was nodular , and the surface was irregular about 24.39 % ( 46 / 189 , 95 % CI : 18.22 , 30.46 % ) .
In some cases , the cervix was smooth and abnormal , accounting for 13.76 % of the cases ( 26 / 189 , 95 % CI : 8.85 , 18.67 % ) .

2 . Imaging examination of cervical micro - thyroid carcinoma : 63 cases of ultrasonic examination : abnormal cervix echo and 24 cases of uterine cavity fluid ;
There were 19 cases of cervical enlargement .
No obvious abnormality was found in 8 cases .
7 cases of cervical occupying lesion ;
Multiple cystic changes of cervix were found in 5 cases .

3 . Cytological examination of cervical microadenoma : The positive rate of cervical cytology was 8.51 % ( 8 / 94 ) . Most of the patients were able to find positive after multiple ( 2 - 4 ) cytologic screening .

4 . The pathological and histological examination of cervical micro - thyroid carcinoma : The positive rate of CEA was 93.58 % ( 102 / 109 , 95 % CI : 88.98 , 98.18 % ) by cervical biopsy and cervical taper . The positive rate of CEA was 93.58 % ( 102 / 109 , 95 % CI : 88.98 , 98.18 % ) .
The positive rate of P53 was 75.00 % ( 42 / 56 , 95 % CI : 63.66 , 86.34 ) ;
The positive rate of Ki - 67 was 100 % ( 41 / 41 ) .
The positive rate of ER was 0 % ( 0 / 34 ) .
The positive rate of CA125 was 10.34 % ( 3 / 29 , 95 % CI : 0.00 , 21.43 % ) .

5 . Treatment of cervical micro - thyroid carcinoma : surgical treatment , postoperative adjuvant radiotherapy and chemotherapy ;
Early diagnosis , clinical staging and surgical methods are of particular importance to the prognosis of patients .

Conclusion : The clinical symptoms and signs of cervical micro - thyroid carcinoma are not obvious , the diagnosis is difficult , and the diagnosis is easy to missed and misdiagnosed . The positive rate of cytologic screening is low , and the diagnosis accuracy of the disease can be improved by immunohistochemistry . The diagnosis accuracy of the disease can be improved by immunohistochemistry . Before operation , the diagnosis accuracy of the disease can be improved . Before operation , the diagnosis accuracy of the disease can be improved . Before operation , the diagnosis accuracy of the disease can be improved .

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

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