淋巴结切除数目及腹主动脉旁淋巴结切除对子宫内膜癌预后的影响

发布时间：2018-05-27 02:05

本文选题：子宫内膜癌 + 淋巴结切除数目　；参考：《郑州大学》2014年硕士论文

【摘要】：背景与目的子宫内膜癌（endometrial carcinoma，EC）是女性生殖道三大恶性肿瘤之一，发病率呈逐年上升趋势，严重威胁了女性的健康。子宫内膜癌的治疗方法主要以手术为主，根据术后病理决定是否行放疗、化疗、激素治疗以及生物治疗等辅助治疗。国际妇产科联盟(International Federation of Gynecology and Obstetrics，FIGO)对手术治疗的患者进行手术-病理分期，强调了切除腹主动脉旁淋巴结的重要意义。然而，进行系统性的分期手术的价值是治疗手段还是预后判断、系统性的盆腔淋巴结切除（pelvic lymphadenectomy, PLD)和腹主动脉旁淋巴结切除（para-aortic lymphadenectomy, PALD）的必要性和切除范围一直存在着较大的争议。淋巴结是外周免疫器官，是T细胞和B细胞定居的场所，也是免疫应答发生的场所，参与淋巴细胞再循环，若切除过多淋巴结，必然破坏了机体免疫系统的完整性。阴性淋巴结过多的切除对预后是否产生影响也值得思考。本文探讨了腹主动脉旁淋巴结切除对子宫内膜癌患者预后的影响，以及切除盆腔淋巴结及腹主动脉旁淋巴结的总数目和阴性淋巴结数目对子宫内膜癌患者预后的影响。资料与方法 1、资料来源：分析2004年01月-2013年06月期间在郑州大学第二附属医院行系统性盆腔淋巴结切除，同时行或不行腹主动脉旁淋巴结切除的206例子宫内膜癌患者的临床资料。应用查看门诊复诊病历和电话随访结合的方式获得随访结果，如果两种方式都不能获得结果，按失访病例处理，失访病例舍弃。 2、预后指标：通过比较患者的复发率、3年生存率、5年生存率来评价患者的预后。 3、统计方法：本文的临床资料数据采用SPSS17．0软件进行统计学分析，年龄和随访时间均描述为平均值±标准差。采用χ2检验分别分析腹主动脉旁淋巴结切除、淋巴结总数、淋巴结阴性数对子宫内膜癌预后的影响以及腹主动脉旁淋巴结切除对患者术后及术后并发症发生率的影响。应用Logisitic回归分析腹主动脉旁淋巴结切除、术后辅助治疗、切除淋巴结阴性数目对患者预后的影响。应用寿命表法进行生存率的分析。检验水准设定为α=0.05，均采用双侧分布，P＜0.05有统计学差异。结果 1、对Ⅰ期、Ⅱ期患者，切除腹主动脉旁淋巴结与否子宫内膜癌患者术后复发率差异无统计学意义（P=0.475＞0.05，P=0.052＞0.05），Ⅲ期患者PALD+PLD组与PLD组的子宫内膜癌患者术后复发率差异有统计学意义（P=0.016＜0.05），对总体而言，是否切除腹主动脉旁淋巴结子宫内膜癌患者术后复发率差异有统计学意义（P=0.034＜0.05）。因为Ⅳ期总例数只有2例，均进行腹主动脉旁淋巴结切除，故不进行统计学分析。 2、对于Ⅰ期、Ⅱ期患者，淋巴结总数≥20个与淋巴结总数＜20个术后复发率差异无统计学意义（P=0.298＞0.05，P=0.640＞0.05），Ⅲ期患者淋巴结总数≥20个与淋巴结总数＜20个术后复发率差异有统计学意义（P=0.008＜0.05），对总体而言，切除淋巴结总数≥20个与淋巴结总数＜20个术后复发率差异无统计学意义（P=0.263＞0.05）。因为Ⅳ期总例数只有2例，且淋巴结总数均≥20个，故不进行统计学分析。 3、对于Ⅰ期、Ⅱ期患者，阴性淋巴结数≥20个与阴性淋巴结数＜20个术后复发率差异无统计学意义（P=0.298＞0.05，P=0.640＞0.05），Ⅲ期患者阴性淋巴结数≥20个与阴性淋巴结数＜20个术后复发率差异有统计学意义（P=0.047＜0.05），对总体而言，切除阴性淋巴结数≥20个与阴性淋巴结数＜20个术后复发率差异无统计学意义（P=0.190＞0.05）。因为Ⅳ期总例数只有2例，且阴性淋巴结数目均≥20个，故不进行统计学分析。 4、切除阴性淋巴结数目与淋巴结总数呈正相关，相关系数r=0.971，P=0.000＜0.05。 5、腹主动脉旁淋巴结切除、术后辅助治疗、阴性淋巴结数目≥20个是子宫内膜癌术后复发率的影响因素（P＜0.05），可以降低患者复发率（OR＜1）。 6、本研究207例患者中共有20例出现术中术后并发症，占总数的9.76%，其中行腹主动脉旁淋巴结切除组中有16例出现并发症，占17.39%，不切除腹主动脉旁淋巴结组中有4例患者出现并发症，占3.54%。腹主动脉旁淋巴结切除组与不切除腹主动脉旁淋巴结组术中术后并发症发生率差异有统计学意义（P=0.001＜0.05）。 7、PALD+PLD组Ⅰ期、Ⅱ期患者3年生存率均为100%，5年生存率分别为100%、96%，Ⅲ期患者3年生存率为93%，5年生存率为72%；PLD组Ⅰ期、Ⅱ期患者3年生存率均为100%，5年生存率分别为98%、80%，Ⅲ期患者3年生存率为77%，5年生存率为68%。阴性淋巴结≥20个组Ⅰ期、Ⅱ期患者3年生存率均为100%，5年生存率均为100%，Ⅲ期患者3年生存率为92%，5年生存率为75%；阴性淋巴结＜20个组Ⅰ期、Ⅱ期患者3年生存率均为100%，5年生存率分别为97%、82%，Ⅲ期患者3年生存率为76%，5年生存率为67%。因为Ⅳ期患者只有2例，均进行腹主动脉旁淋巴结切除，且切除阴性淋巴结数均≥20个，，不进行生存率的分析。结论 1、理想的腹主动脉旁淋巴结的切除可以降低Ⅲ期子宫内膜癌患者的复发率，但对于Ⅰ期、Ⅱ期患者的预后改善作用不明显。 2、淋巴结切除总数≥20个可以降低Ⅲ期子宫内膜癌患者术后复发率，切除阴性淋巴结数≥20个并不影响患者生存期。
[Abstract]:Background and purpose
Endometrial carcinoma (EC) is one of the three major malignant tumors in female genital tract. The incidence of endometriosis is increasing year by year, which seriously threatens the health of women. The main treatment methods for endometrial cancer are surgery based on radiotherapy, chemical therapy, hormone therapy and biological therapy. The International Federation of Gynecology and Obstetrics, FIGO) performed surgical pathological staging to patients with surgical treatment, emphasizing the importance of excision of the paraaortic lymph nodes. However, the value of systematic staging is the treatment and prognosis, and systematic pelvic lymph node excision (pelvi). C lymphadenectomy, PLD) and para aortic lymph node excision (para-aortic lymphadenectomy, PALD) have a great controversy. The lymph nodes are peripheral immune organs, are the sites for the settlement of T cells and B cells, and are the sites of the immune response, participating in the lymphocytic recirculation, if excessively many lymph nodes are removed. The effects of excision of the negative lymph nodes on the prognosis of the patients with endometrial carcinoma, and the total number of lymph nodes and the total number of lymph nodes in the para aorta and the number of negative lymph nodes were discussed. The effect on the prognosis of endometrial cancer patients.
Information and methods
1. Data sources: analysis of the clinical data of 206 patients with endometrial cancer who underwent systemic pelvic lymph node resection in the Second Affiliated Hospital of Zhengzhou University, 01 months -2013, 2004, during 06 months of 06 months. Fruit can not be obtained in two ways. According to the lost cases, the case is abandoned.
2, prognostic indicators: the prognosis was evaluated by comparing the recurrence rate, the 3 year survival rate and the 5 year survival rate.
3, statistical methods: the clinical data of this article were statistically analyzed with SPSS17.0 software. Age and follow-up time were described as mean standard deviation. The effect of lymph node resection, total number of lymph nodes, negative number of lymph nodes on the prognosis of endometrial carcinoma and the lymph node of abdominal aorta were analyzed by Chi 2 test. The effect of resection on the incidence of postoperative and postoperative complications. Logisitic regression analysis was used to analyze the effect of lymph node dissection of the abdominal aorta, the postoperative adjuvant treatment, the effect of the negative number of lymph nodes on the prognosis of the patients. The life table method was used to analyze the survival rate. The test level was set as alpha =0.05, both were bilateral distribution, P < 0.05 had statistics. Learning differences.
Result
1, there was no statistically significant difference in the recurrence rate of patients with stage I, stage II, para aortic lymph nodes or endometrial carcinoma (P=0.475 > 0.05, P=0.052 > 0.05). The recurrence rate of endometrial cancer patients in group PALD+PLD and PLD group was statistically significant (P=0.016 < 0.05). The postoperative recurrence rate of the patients with para arterial lymphadenocarcinoma was statistically significant (P=0.034 < 0.05). Because the total number of cases in stage IV was only 2 cases, the lymph node dissection of the abdominal aorta was performed, so no statistical analysis was performed.
2, for stage I and stage II patients, there was no statistical significance (P=0.298 > 0.05, P=0.640 > 0.05) for the total number of lymph nodes more than 20 and the total number of lymph nodes (P=0.298 > 0.05, P=0.640 > 0.05). There was a statistical significance (P=0.008 < 0.05) for the recurrence rate of the total number of lymph nodes more than 20 and the total number of lymph nodes in stage III patients (P=0.008 < 0.05). There was no statistically significant difference in the recurrence rate between the number of more than 20 lymph nodes and the total number of lymph nodes (P=0.263 > 0.05). The total number of cases in stage IV was only 2, and the total number of lymph nodes were more than 20, so no statistical analysis was performed.
3, for stage I, stage II patients, there was no statistically significant difference between 20 negative lymph node number and negative lymph node number and negative lymph node number (P=0.298 > 0.05, P=0.640 > 0.05). There were statistical significance (P=0.047 < 0.05) for the recurrence rate of the negative lymph node number more than 20 and negative lymph nodes in stage III patients (P=0.047 < 0.05). There was no statistically significant difference between the number of negative lymph nodes or negative lymph nodes and the number of negative lymph nodes (P=0.190 > 0.05) (P=0.190 > 0.05), because the number of total cases in stage IV was only 2, and the number of negative lymph nodes was more than 20, so no statistical analysis was performed.
4, the number of negative lymph nodes was positively correlated with the total number of lymph nodes, and the correlation coefficient r=0.971, P=0.000 < 0.05.
5, para aortic lymph node resection, postoperative adjuvant treatment and negative lymph node number more than 20 were the factors affecting the recurrence rate after endometrial carcinoma (P < 0.05), which could reduce the recurrence rate of patients (OR < 1).
6, in this study, there were 20 cases of postoperative complications in 207 patients, accounting for 9.76% of the total, of which 16 cases in the para aortic lymph node resection group had complications, accounting for 17.39%, and 4 patients in the non resected para aortic lymph node group had complications, which accounted for 3.54%. abdominal aorta resection group and non abdominal aorta removal. The incidence of intraoperative and postoperative complications in lymph node group was statistically significant (P=0.001 < 0.05).
7, group I, stage I, stage II, 3 year survival rate was 100%, 5 year survival rate was 100%, 96%, 96%, 3 year survival rate was 93%, 5 year survival rate was 72%; PLD group I, stage II patients were 100%, 5 year survival rate was 100%, 100% period survival rate was 68%. negative lymph node group. The 3 year survival rate was 100%, the 5 year survival rate was 100%, the 3 year survival rate was 92%, the 5 year survival rate was 75%, the negative lymph nodes < 20 group I, the 3 years survival rate of 3 years were 100%, 5 year survival rate was respectively, the survival rate was 67%. All cases underwent resection of the para aortic lymph nodes, and the number of negative lymph nodes was more than 20. No survival rate was analyzed.
conclusion
1, the ideal resection of the para aortic lymph nodes can reduce the recurrence rate of patients with stage III endometrial carcinoma, but it is not significant for the prognosis of stage I and stage II patients.
2, the total number of lymph node excision is more than 20, which can reduce the recurrence rate of patients with stage III endometrial cancer, and the number of negative lymph nodes more than 20 can not affect the survival time of patients.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

【参考文献】