阴道癌的治疗方法和预后因素的临床及Meta分析研究

发布时间：2018-07-24 20:05

【摘要】：影响阴道癌预后的临床病理因素分析目的：探讨影响原发性阴道癌预后的临床病理因素。方法：对1985年-2012年间广西医科大学附属肿瘤医院进行完整治疗的有病理诊断、病历资料及随访的60例阴道恶性肿瘤患者进行回顾性分析,分析年龄、绝经与否、FIGO临床分期、有无子宫切除史、病理类型、肿瘤大小、阴道受侵长度、民族、治疗方法等对患者预后的影响,使用寿命表法及Kaplan-Meier计算生存率,差异性经Log-rank test进行检验,并用COX模型进行多因素的分析。结果：单因素生存分析结果显示,鳞癌患者的预后比非鳞癌患者的预后要好,并且FIGO临床分期越晚,阴道受侵长度越长,患者的预后就越差,差异有统计学意义(P0.05)。多因素分析结果显示,FIGO临床分期、病理类型是影响阴道癌预后的主要危险因素。结论：影响阴道癌预后的临床病理因素主要有FIGO临床分期、病理类型,阴道受侵长度越长,患者的预后就越差。放疗及手术在阴道癌治疗价值的Meta分析目的：评价放疗及手术在阴道癌治疗中的价值。方法：检索中国生物医学文献数据库、中国知网、Pubmed。筛选符合纳入标准的2003年1月1日至2013年10月30日公开发表的评价了放疗(±化疗)、手术(±化疗)、放疗+手术(±化疗)等治疗方法对于阴道癌预后影响的国内外论文,以生存率为观察指标,原始文献中有明确的随访截尾数据。对各研究间的异质性及对提取的各个效应量用统计软件STATAl1.0进行合并与统计推断。结果：纳入的4个研究中,手术、放疗、手术+放疗之间的5年生存率差异并无统计学意义。结论：Meta分析的结果显示不同的治疗方法之间的5年生存率差异并无统计学意义,阴道癌的治疗需综合患者的一般情况、临床分期、病理类型、癌灶部位等因素,在尽可能安全及减少治疗后并发症的前提下,采用单纯手术、单纯放疗或手术+放疗等治疗方案,并辅以化疗改善预后。
[Abstract]:Analysis of clinicopathological factors influencing the prognosis of vaginal carcinoma objective: to explore the clinicopathological factors affecting the prognosis of primary vaginal carcinoma. Methods: from 1985 to 2012, 60 patients with vagina malignant tumor who underwent complete treatment in the affiliated Cancer Hospital of Guangxi Medical University were retrospectively analyzed. The age, menopausal stage and Figo clinical stage were analyzed. The influence of history of hysterectomy, pathological type, tumor size, length of vagina invasion, nationality, treatment methods on the prognosis of the patients. The survival rate was calculated by using life table method and Kaplan-Meier. The difference was tested by Log-rank test. COX model was used to analyze multiple factors. Results: the results of univariate survival analysis showed that the prognosis of patients with squamous cell carcinoma was better than that of patients with non-squamous cell carcinoma, and the later the clinical stage of FIGO was, the longer the length of vagina invasion was, the worse the prognosis of patients was (P0.05). Multivariate analysis showed that Figo staging and pathological type were the main risk factors for the prognosis of vaginal carcinoma. Conclusion: the main clinicopathologic factors influencing the prognosis of vaginal carcinoma are FIGO staging, pathological type, and the longer the length of vaginal invasion, the worse the prognosis of the patients. Meta analysis of the value of radiotherapy and surgery in the treatment of vaginal carcinoma objective: to evaluate the value of radiotherapy and surgery in the treatment of vaginal carcinoma. Methods: the Chinese biomedical literature database was searched. From January 1, 2003 to October 30, 2013, papers were published to evaluate the effect of radiotherapy (卤chemotherapy), surgery (卤chemotherapy) and radiotherapy (卤chemotherapy) on the prognosis of vaginal cancer. The survival rate was used as the observation index, and the follow-up data were clear in the original literature. The heterogeneity of each study and the extraction of each effect quantity were combined and inferred by statistical software STATAl1.0. Results: there was no significant difference in 5-year survival rate between surgery, radiotherapy and surgical radiotherapy. Conclusion there is no significant difference in 5-year survival rate among different treatment methods. The treatment of vaginal cancer needs to integrate the general situation of patients, clinical stage, pathological type, location of cancer, and so on, conclusion the results of the meta-analysis showed that there was no significant difference in the 5-year survival rate among the different treatments. Under the premise of as safe as possible and reducing the complications after treatment, simple operation, simple radiotherapy or surgical radiotherapy were used, and chemotherapy was used to improve the prognosis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.34

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