乳腺、肺双原发癌的临床病理特征及预后分析

发布时间：2018-03-17 00:24

本文选题：乳腺癌　切入点：双原发癌　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析乳腺、肺双原发癌(double primary cancers)患者的临床病理学特征,探讨影响乳腺、肺双原发癌患者预后的相关因素。方法选取2000年1月至2015年12月经天津肿瘤医院手术和临床病理诊断为乳腺癌合并肺癌128例的双原发癌患者,其中乳腺病理是经由乳腺病理确诊,肺病理是经由大病理确诊。全组均为女性。对乳腺、肺双原发癌患者的发病情况进行分析。按发病时间间隔,将乳腺、肺双原发癌患者分为同时性双原发癌与异时性双原发癌,将两组的临床病理学特征及预后进行了分析比较。按照乳腺癌或肺癌的发病时间顺序先后,分为乳腺癌首发双原发癌和肺癌首发双原发癌,进行临床病理学特征进行分析比较,并探讨影响双原发癌患者预后的相关因素。采用SPSS21.0统计软件进行分析。各组数据间的比较采用χ2检验,应用Kaplan-Meier法进行生存分析,单因素分析采用Log rank检验,多因素分析采用Cox比例风险回归模型。P0.05为差异具有统计学意义。结果128例乳腺、肺双原发癌患者中,占同期乳腺癌的0.2%(128/44705)、同期女性肺癌的1%(128/12637)。同时性双原发癌有5人,异时性双原发癌有123人。乳腺癌作为第一原发癌合并肺癌有113例、肺癌作为第一原发癌合并乳腺癌有15例。有39%的患者诉有肿瘤家族史。63.2%的患者已闭经。在首发乳腺癌与首发肺癌的自查或查体的肺癌发现方式上具有统计学意义(0.000.05);在气管镜检查、针吸、手术这三种肺癌确诊方式上有统计学意义(0.030.05);在肺癌临床分期上有统计学意义(0.020.05);在肺癌区域淋巴结分期上具有统计学意义(0.000.05)。乳腺癌首发的双原发癌与肺癌首发的双原发癌两组之间的差异具有统计学意义,肺癌首发的双原发癌患者较乳腺癌首发的双原发癌患者预后差(P=0.002)。同时性双原发癌与异时性双原发癌两组之间的差异具有统计学意义,同时性双原发癌患者较异时性双原发癌患者预后差(P=0.00)。在肺癌病理类型之间差异有统计学意义。肺癌病理类型是影响患者预后的因素(P0.05)。首发癌的确诊年龄、乳腺癌组织学分级、肺癌病理类型是乳腺、肺双原发癌患者的独立预后因素。首发癌确诊年龄越晚、乳腺癌组织学分级高、肺癌病理类型不同为乳腺、肺双原发癌患者预后不良的独立危险因素。结论1.共选取了128例乳腺、肺双原发癌女性患者资料,中位年龄59岁,占同期乳腺癌的0.2%(128/44705)、同期女性肺癌的1%(128/12637),其中乳腺癌作为第一原发癌合并肺癌有113例、肺癌作为第一原发癌合并乳腺癌有15例。2.由于肺癌的临床症状往往较为隐匿,常不被发觉,通常有症状再发现通常致分期较晚,在此128位患者中有大多数是乳腺癌首发的,在综合治疗之后会定期复查,复查手段里包括了胸部影像学检查,对发现肺部病灶有很大的作用。因此我们针对肺癌的发现、确诊方式、临床分期、肿瘤最大直径、区域淋巴结分期来分析。在首发乳腺癌与首发肺癌的自查或查体的肺癌发现方式上具有统计学意义;在气管镜检查、针吸、手术这三种肺癌确诊方式上有统计学意义;在肺癌临床分期上有统计学意义;在肺癌区域淋巴结分期上具有统计学意义。因为有定期的影像学检查,所以能更早的发现肺部病灶的发生。3.乳腺癌首发的双原发癌与肺癌首发的双原发癌两组之间的差异具有统计学意义,肺癌首发的双原发癌患者较乳腺癌首发的双原发癌患者预后差。同时性双原发癌与异时性双原发癌两组之间的差异具有统计学意义,同时性双原发癌患者较异时性双原发癌患者预后差。肺癌病理类型是影响患者预后的因素。4.首发癌的确诊年龄、乳腺癌组织学分级、肺癌病理类型是乳腺、肺双原发癌患者的独立预后因素。
[Abstract]:Objective to analyze the breast, lung, double primary cancer (double primary cancers) clinical and pathological characteristics of patients, to explore the influence factors related to breast cancer prognosis of patients with double primary lung. Methods from January 2000 to 2015 12 menstrual Tianjin Cancer Hospital surgery and clinical pathological diagnosis of breast cancer with lung cancer in 128 cases of double primary cancer patients. One is through the pathological diagnosis of breast pathology of breast, lung pathology is through pathology. All the patients were female. The breast, analyzed the incidence of patients with double primary pulmonary carcinoma. The breast according to onset time interval, double primary pulmonary carcinoma patients were divided into synchronous double primary cancer and metachronous double primary cancer, the clinical pathological characteristics and prognosis of the two groups were analyzed and compared. According to the time sequence of onset of breast cancer or lung cancer were divided into breast carcinoma presenting double primary cancer and lung cancer the first primary cancer, clinical pathology Characteristics were analyzed and compared, and the factors related to the prognosis of patients with double primary carcinoma. Were analyzed by SPSS21.0 statistical software. The data were compared using chi square test 2, by using the method of Kaplan-Meier survival analysis, univariate analysis using the Log rank test, multivariate analysis using Cox proportional hazards regression model for the difference is.P0.05 statistical significance. Results 128 cases of breast, double primary pulmonary carcinoma, breast cancer accounted for 0.2% (128/44705), over the same period of female lung cancer 1% (128/12637). At the same time of double primary carcinoma 5, metachronous multiple primary carcinoma 123. Breast cancer as the first primary carcinoma there were 113 cases of lung cancer, lung cancer as the first primary carcinoma in patients with breast cancer in 15 cases. 39% patients complained of.63.2% family history of cancer patients have amenorrhea. With the self in the first breast cancer and lung cancer or first examination found on lung cancer Statistically significant (0.000.05); in bronchoscopy, needle aspiration, operation was significant of the three lung cancer diagnosis method (0.030.05); there was statistical significance in the clinical staging of lung cancer (0.020.05) in lung cancer; lymph node staging area with statistical significance (0.000.05). The difference was statistically significant between the two groups the first two breast cancer primary cancer and lung cancer first double primary carcinoma of lung cancer, the first double primary cancer patients with breast cancer the first double primary cancer patients with poor prognosis (P=0.002). At the same time has statistical significance of double primary cancer and metachronous multiple primary carcinoma of the differences between the two groups. At the same time of double primary cancer patients with metachronous primary cancer patients with poor prognosis (P=0.00). The pathological type of lung cancer was statistically significant. The pathological type of lung cancer is a prognostic factor (P0.05). The age of diagnosis of the first cancer, histological grade of breast cancer, The pathological type of lung cancer is an independent prognostic factor in patients with breast and lung cancer. The first double primary cancer diagnosis of the late age, histological grade of breast cancer, the pathological type of lung cancer in different breast, independent risk factors for pulmonary double primary cancer in patients with poor prognosis. Conclusion: 1. a total of 128 cases of mammary gland, two primary lung the information of cancer of female patients, median age 59 years, accounted for 0.2% of breast cancer (128/44705), over the same period of female lung cancer 1% (128/12637), including breast cancer as the first primary carcinoma in 113 cases with lung cancer, lung cancer as the first primary cancer associated with breast cancer in 15 cases of.2. due to the clinical symptoms of lung cancer often more hidden, often are not found, usually have symptoms usually caused by late stage and found that, in 128 patients with breast cancer is the most first, in the comprehensive treatment after regular review, review methods include chest imaging, found in lung disease Kitchen has a great effect. So we found for lung cancer, diagnosis, clinical staging, tumor diameter, lymph node staging analysis. Statistical significance of self-examination in the starting of breast cancer and lung cancer or first examination found the way in lung cancer; bronchoscope examination, needle aspiration, operation was significant these three kinds of methods in the diagnosis of primary lung cancer; clinical staging of lung cancer was statistically significant; in the regional lymph node staging of lung cancer was statistically significant. Because there are regular imaging, so have found statistically significant differences between the two groups of pulmonary lesions occurred in.3. breast cancer first double primary cancer and lung cancer the first double primary carcinoma of lung cancer, the first double primary cancer patients with breast cancer the first primary cancer patients with poor prognosis. At the same time of double primary cancer and metachronous multiple primary carcinoma between the two groups has difference Statistical significance of double primary cancer patients with poor prognosis and double primary cancer patients with different pathological types of lung cancer is diagnosed. The age factors influencing the prognosis of patients with.4. onset cancer, histological grade of breast cancer tissue, the pathological type of lung cancer is breast, independent pre double primary cancer in patients with pulmonary factors.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9;R734.2

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