声带白斑术后复发及癌变相关预后因素研究

发布时间：2018-03-14 22:30

  本文选题：声带白斑　切入点：复发　出处：《浙江大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析影响声带白斑术后复发、癌变的相关预后因素。方法回顾性分析于1998年1月～2013年12月期间在本院首次手术治疗的416例声带白斑患者的临床资料,采用Kaplan-Meier法计算术后1、3、5年复发率和癌变率,并用采用Log-Rank法分析性别、年龄、病程、吸烟、酗酒、白斑范围、累及前连合、手术方式、组织病理与声带白斑术后复发、癌变的关系,筛选与术后复发、癌变相关的变量,进入COX多因素回归模型分析,计算这些因素的相对风险比(Hazard ratio,HR)。结果416例声带白斑患者中,107例术后复发,43例术后癌变,1、3、5年复发率分别为 9.4%、19.9%、24.3%,1、3、5 年癌变率分别为 1.9%、6.3%、9.3%。复发相关的单因素分析结果显示:年龄,病程,白斑范围,累及前连合,手术方式,组织病理这六项因素与声带白斑术后复发相关。将这些因素进入术后复发COX多因素回归模型分析,得出白斑范围,累及前连合,手术方式,组织病理是影响声带白斑术后复发的预后因素,而年龄,病程不是影响声带白斑术后复发的预后因素。白斑范围≥1/2组的术后复发风险是1/2组的1.73倍;白斑累及前连合组的术后复发风险是未累及前连合组的2.19倍。支撑喉镜显微镜下CO2激光手术组的术后复发风险是支撑喉镜显微镜下声带黏膜剥脱术组的0.34倍。中度异型增生组的术后复发风险是鳞状上皮增生组的2.58倍,而重度异型增生组的术后复发风险是鳞状上皮增生组的5.80倍。癌变相关的单因素分析结果显示:年龄,白斑范围,累及前连合,组织病理四项因素与声带白斑术后癌变相关。将这些因素进入术后癌变COX多因素回归模型分析,得出累及前连合,组织病理是影响声带白斑术后癌变的预后因素,而年龄,白斑范围不是影响声带白斑术后癌变的预后因素。白斑累及前连合组的术后癌变风险是未累及前连合组的3.05倍。轻度异型增生组的术后癌变风险是鳞状上皮增生组的3.51倍,中度异型增生组的术后癌变风险是鳞状上皮增生组的16.92倍,重度异型增生组的术后癌变风险是鳞状上皮增生组的44.24倍。结论:白斑范围,累及前连合,手术方式,组织病理是影响声带白斑术后复发的预后因素;白斑的范围越广,声带白斑术后复发风险越高;白斑累及前连合,声带白斑术后的复发风险高;白斑的组织病理分级越高,声带白斑术后复发风险越高。累及前连合,组织病理是影响声带白斑术后癌变的预后因素;白斑累及前连合,声带白斑术后癌变风险高;白斑的组织病理分级越高,声带白斑术后癌变风险越高。
[Abstract]:Objective to analyze the effect of postoperative recurrence of leukoplakia and related prognostic factors of cancer. Methods a retrospective analysis from January 1998 to December 2013 in our hospital for the first time during the surgical treatment of 416 cases of vocal cord leukoplakia in patients with clinical data, calculate the postoperative 1,3,5 recurrence rate and canceration rate by Kaplan-Meier method, and Log-Rank method was used to analyze gender, age. The course of disease, smoking, alcoholism, leukoplakia, anterior commissure involvement, surgery, tissue pathology and postoperative recurrence of leukoplakia canceration, the relationship between screening and postoperative recurrence of cancer related variables into the COX regression model analysis, calculate the relative risk of these factors than (Hazard ratio, HR). Results 416 cases of vocal cord leukoplakia, 107 cases of postoperative recurrence, 43 cases of canceration of postoperative 1,3,5 recurrence rates were 9.4%, 19.9%, 24.3%, 1,3,5 years canceration rate were 1.9%, 6.3%, and single factor analysis of recurrence of 9.3%. related The results show that the age, course of disease, leukoplakia, anterior commissure involvement, surgery, pathology of the six factors and vocal leukoplakia postoperative recurrence and related. These factors enter the multi factors of recurrence after COX regression analysis, the white spot area, anterior commissure involvement, surgery, pathology were prognostic factors. The postoperative recurrence of vocal cord leukoplakia and age, prognostic factors of recurrence of leukoplakia postoperative course is not affected. The white spots above 1/2 group the recurrence risk is 1.73 times higher than that of 1/2 group; leukoplakia involving the anterior commissure group the postoperative recurrence risk is 2.19 times without involvement of the anterior commissure laryngoscope under the microscope group. CO2 laser the surgery group the recurrence risk is the laryngoscope under the microscope to peel off vocal mucosa 0.34 times surgery group. Moderate dysplasia group of postoperative recurrence risk is 2.58 times of squamous epithelial hyperplasia group, and severe dysplasia group postoperative rehabilitation The risk is 5.80 times of squamous epithelial hyperplasia group. Cancer related results of univariate analysis showed that age, white spots, the anterior commissure involvement, pathological factors and four postoperative vocal cord Leukoplakia Carcinogenesis related. These factors will enter cancer after multi factor COX regression model analysis, the anterior commissure involvement is pathology the factors affected the prognosis of cancer, postoperative vocal cord leukoplakia and the age range is not affected, leukoplakia of vocal cord leukoplakia canceration. Postoperative prognostic factors of leukoplakia involving the anterior commissure of postoperative cancer risk is 3.05 times without involvement of the anterior commissure group. Mild heterotypic hyperplasia group of postoperative cancer risk is 3.51 times of squamous epithelial hyperplasia group. Moderate dysplasia group of postoperative cancer risk is 16.92 times of squamous epithelial hyperplasia group, severe dysplasia group postoperative cancer risk is 44.24 times of squamous epithelial hyperplasia group. Conclusion: the white spots, even involving the former Combined surgery, pathology were prognostic factors for recurrence after resection of vocal cord leukoplakia leukoplakia; range more widely, leukoplakia recurrence risk is higher; leukoplakia involving the anterior commissure, the risk of postoperative recurrence of vocal cord leukoplakia leukoplakia; pathological grade is higher, the vocal cords of white spot recurrence risk is higher involving the anterior commissure. Histopathology, were prognostic factors for postoperative cancer leukoplakia; leukoplakia involving the anterior commissure, leukoplakia postoperative cancer risk; histopathological grading leukoplakia is higher, postoperative vocal cord leukoplakia cancer risk is higher.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R767.91
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本文编号：1613244