上皮性卵巢癌预后的相关因素分析

发布时间：2018-05-02 04:01

本文选题：上皮性卵巢癌 + 中性粒细胞与淋巴细胞比值　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:探讨上皮性卵巢癌的预后影响因素,为进一步的合理治疗提供依据。方法:收集2009年1月1日至2011年7月1日于河北医科大学第四医院妇科初治的267例上皮性卵巢癌患者的临床资料,采用回顾性分析的方法,对患病年龄、初潮年龄、绝经情况、孕产次、绝育术史、恶性肿瘤家族史、合并子宫内膜异位性疾病、初治时及化疗3程后CA125水平、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、淋巴细胞与单核细胞比值(lymphocyte-to-monocyte ratio,LMR)、腹水情况、卵巢肿瘤生长情况、腹膜后淋巴结切除情况、残余灶大小、病理类型、组织分化程度、国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)分期及术后化疗情况与上皮性卵巢癌患者预后的关系进行研究。通过建立受试者工作特征曲线(receiver operating characteristic curve,ROC曲线),确定术前外周血NLR及LMR判断预后的最佳截点。采用Kaplan-Meier法进行生存分析,Cox逐步回归法分析影响预后的独立因素。结果:1截至2016年7月1日,267例上皮性卵巢癌患者中死亡125例,3年、5年生存率分别为70.2%、50.6%;复发168例,3年、5年无进展生存率分别为45.6%、34.3%。2单因素分析显示患病年龄、初潮年龄、是否绝经、初治时CA125水平、化疗3程后CA125水平、NLR、LMR、有无腹水、腹水或腹腔冲洗液中有无癌细胞、卵巢肿瘤单双侧生长、是否行淋巴结切除、淋巴结转移、残余灶大小、病理类型、分化程度、FIGO分期及术后化疗疗程与患者的总生存期有关(P0.05)。患病年龄、初潮年龄、恶性肿瘤家族史、初治时CA125水平、化疗3程后CA125水平、NLR、LMR、有无腹水、腹水或腹腔冲洗液中有无癌细胞、卵巢肿瘤单双侧生长、卵巢肿瘤直径、是否行淋巴结切除、淋巴结转移、残余灶大小、病理类型、分化程度、FIGO分期及术后化疗疗程与患者的无进展生存期有关(P0.05)。3多因素分析显示化疗3程后CA125水平、卵巢肿瘤单双侧生长、病理类型、分化程度及FIGO分期是影响上皮性卵巢癌患者总生存期的独立预后因素(P0.05)。初治时CA125水平、化疗3程后CA125水平、NLR、卵巢肿瘤单双侧生长、病理类型、分化程度及FIGO分期是影响上皮性卵巢癌患者无进展生存期的独立预后因素(P0.05)。结论:化疗3程后CA125水平、卵巢肿瘤单双侧生长、病理类型、分化程度及FIGO分期是影响上皮性卵巢癌患者总生存期及无进展生存期的独立预后因素。初治时CA125水平和NLR为影响患者无进展生存期的独立预后因素。
[Abstract]:Objective: to explore the prognostic factors of epithelial ovarian cancer and to provide evidence for further rational treatment. Methods: from January 1, 2009 to July 1, 2011, 267 patients with epithelial ovarian cancer were collected from the fourth Hospital of Hebei Medical University. The age of disease, age of menarche and menopause were analyzed retrospectively. Pregnancy and childbirth, history of sterilization, family history of malignant tumor, complicated with endometriosis, CA125 level at first treatment and after chemotherapy, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, ascites, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte LMRs, ascites, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte / monocyte ratio, ascites, neutrophil-to-lymphocyte ratio, Ovarian tumor growth, retroperitoneal lymphadenectomy, residual lesion size, pathological type, tissue differentiation, The relationship between the stage of International Federation of Gynecology and Obstetrics Figo and the prognosis of patients with epithelial ovarian cancer was studied. By setting up the receiver operating characteristic curve, the best point for judging the prognosis of peripheral blood NLR and LMR before operation was determined. Survival analysis was performed by Kaplan-Meier method and Cox stepwise regression was used to analyze the independent prognostic factors. Results as of July 1, 2016, 125 of 267 patients with epithelial ovarian cancer died, the 3-year and 5-year survival rates were 70.22 and 50.6, respectively, and the survival rates of 168 relapses, 3 years, and 5 years without progression were 45.634. 34.2%. Single factor analysis showed that the age of disease, the age of menarche, whether menopause was menopausal. At the beginning of treatment, the level of CA125, the level of CA125 after three stages of chemotherapy, the presence of ascites, the presence of cancer cells in ascites or peritoneal lavage, the unilateral and bilateral growth of ovarian tumors, whether lymph node resection, lymph node metastasis, the size of residual foci, and pathological types were observed. The degree of differentiation and Figo stage and the course of chemotherapy after operation were related to the total survival time of the patients (P 0.05). Age of disease, age of menarche, family history of malignant tumor, CA125 level at first treatment, CA125 level after 3 stages of chemotherapy, ascites, cancer cells in ascites or peritoneal lavage, growth of ovarian tumor unilateral and bilateral, diameter of ovarian tumor. Whether or not lymph node resection, lymph node metastasis, residual lesion size, pathological type, differentiation degree, Figo stage and postoperative chemotherapy course were related to the progression free survival of the patients were correlated with the multivariate analysis of P0.053.The multivariate analysis showed that the level of CA125 was found after 3 stages of chemotherapy. The growth, pathological type, differentiation degree and FIGO stage of ovarian tumors were independent prognostic factors for the overall survival period of patients with epithelial ovarian cancer (EOC). The level of CA125, the level of CA125 after three stages of chemotherapy, the growth, pathological type, differentiation and FIGO stage of ovarian tumors were the independent prognostic factors of progressive survival in patients with epithelial ovarian cancer (EOC). Conclusion: the levels of CA125, unilateral and bilateral growth, pathological type, differentiation degree and FIGO stage are independent prognostic factors in patients with epithelial ovarian cancer after three stages of chemotherapy. CA125 level and NLR were independent prognostic factors for progressive survival.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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