结直肠癌淋巴结外肿瘤种植临床病理学特征及预后研究

发布时间：2018-03-04 08:28

  本文选题：结直肠肿瘤　切入点：淋巴结外肿瘤种植　出处：《青岛大学》2016年博士论文　论文类型：学位论文

【摘要】：目的:探讨结直肠癌患者淋巴结外肿瘤种植(ENTDs)的临床病理学特征及其与预后的关系,从而指导患者临床治疗决策的选择,进一步改善患者的预后。方法:1.采用单中心回顾性研究的方法,选取自2009年6月至2013年6月在青岛大学附属医院普外科行手术治疗的含有ENTDs的结直肠癌患者为研究对象,收集其临床及病理资料,并对其进行随访,运用SPSS15.O统计学软件进行统计分析,生存分析采用kaplan-Meier法计算,单因素预后分析采用Log-Rank法检验,多因素预后分析采用Cox风险回归模型分析。2.检索1990至2014年MEDLINE/Pub Med、Web of Science、Directory of Open Access Journals(DOAJ)、Springer Link等15家国际文献数据库以及中国生物医学文献光盘数据库、中国知网、万方数据库等中文数据库有关结直肠癌患者ENTDs与患者术后生存率关系的研究文献,按纳入和排除标准筛选文献、提取资料和质量评价后,采用Review-Manager5.3软件进行Meta分析。结果:1.本研究伴有ENTDs的结直肠癌患者共64例,占同期结直肠癌患者的5.54%。当ENTDs个数为1个时,其术后5年生存率为50%(24/44),术后中位生存时间为42.5月;当ENTDs个数大于1个时,其术后5年生存率为22.2%(4/18),术后中位生存时间为38.0月。单因素分析结果显示临床形态,组织学类型,T分期,N分期,M分期,脉管浸润,周围神经浸润,术前血清CEA,CA19-9,手术方式,辅助治疗及ENTDs数目是伴ENTDs结直肠癌的预后影响因素。Cox回归分析显示肿瘤组织学类型、T分期及N分期是影响伴ENTDs结直肠癌预后的独立危险因素。2.Meta分析共纳入10篇文献的4068例结直肠癌患者,其中有ENTDs者727例(ENTDs组),不存在ENTDs者3341例(对照组)。Meta分析结果显示:ENTDs组的5年总生存率(OR=0.27,95%CI:0.18-0.43)和5年无复发生存率(OR=0.23,95%CI:0.16-0.34)均明显低于对照组(均P0.00001);亚组分析显示,淋巴结转移阴性组(N0)及淋巴结转移阳性组(N+)结直肠癌患者ENTDs组的5年总生存率均明显低于对照组(均P0.05)。结论:1.伴ENTDs结直肠癌临床大体类型以溃疡型为主,浸润型所占比例亦较高;组织学类型以腺癌为主;分化程度以中、低分化为主;TNM分期主要为Ⅲ期及Ⅳ期;大多数患者术前血清CEA和CA19-9升高。临床形态,组织学类型,T分期,N分期,M分期,脉管浸润,周围神经浸润,术前血清CEA,CA19-9,手术方式,辅助治疗及ENTDs数目是伴ENTDs结直肠癌的预后影响因素。肿瘤组织学类型、T分期及N分期是影响伴ENTDs结直肠癌预后的独立危险因素。2.ENTDs是结直肠癌患者的预后不良因素;ENTDs对结直肠癌患者术后生存率的影响可能类似于局部淋巴结转移,或者介于淋巴结转移和远处转移之间。
[Abstract]:Objective: to investigate the clinicopathological features of extralymph node tumor implants (ENTDs) in patients with colorectal cancer and their relationship with prognosis so as to guide the choice of clinical treatment decisions. Methods 1. Single center retrospective study was used to select colorectal cancer patients with ENTDs who underwent surgical treatment in general surgery department of Qingdao University Hospital from June 2009 to June 2013. The clinical and pathological data were collected and followed up. SPSS15.O software was used for statistical analysis, kaplan-Meier method was used for survival analysis, and Log-Rank method was used for univariate prognostic analysis. Multivariate prognostic analysis using Cox risk regression model analysis .2.Retrieval of 15 international literature databases, such as MEDLINE/Pub Med#en1# of Open Access Journals of Open Journals, Springer Link, and China Biomedical Literature CD-ROM database from 1990 to 2014. Chinese databases such as Wanfang database were used to study the relationship between ENTDs and postoperative survival rate of patients with colorectal cancer. The literature was screened according to the criteria of inclusion and exclusion, and the data was extracted and the quality was evaluated. Review-Manager5.3 software was used to analyze Meta. Results 1. 64 cases of colorectal cancer with ENTDs in this study, accounting for 5.54% of the patients with colorectal cancer. When the number of ENTDs was 1, the 5-year survival rate was 50% 24 / 44%, and the median survival time was 42.5 months. When the number of ENTDs was more than 1, the 5 year survival rate was 22. 2% / 18%, and the median survival time was 38. 0 months. The results of univariate analysis showed that the clinical morphology, histological type, T stage, N stage and M stage, vascular infiltration, peripheral nerve infiltration were observed. Preoperative serum CEA CA19-9, operative method, Adjuvant therapy and number of ENTDs were prognostic factors for colorectal cancer with ENTDs. Cox regression analysis showed that T stage and N stage were independent risk factors for prognosis of colorectal cancer with ENTDs. 2. Meta-analysis included 10 articles. Of 4068 patients with colorectal cancer, Among them, 727 cases with ENTDs and 3341 cases without ENTDs were significantly lower than those in the control group (all P 0.00001). The 5-year overall survival rate was 0.2795% (CI: 0.2795% 0.18-0.43) and the 5-year recurrence free survival rate was 0.2395% (all P0.00001) in the control group (all P0.00001), and the 5-year recurrence free survival rate of 0.2395 CIW 0.16-0.34 in the control group was significantly lower than that in the control group (P < 0.05). The 5-year overall survival rate in ENTDs group was significantly lower than that in control group (P < 0.05). Conclusion 1. The clinical gross types of colorectal cancer with ENTDs were mainly ulcerative type, and the overall survival rate in ENTDs group was significantly lower than that in control group (P < 0.05), both in lymph node metastasis negative group (n 0) and in lymph node metastasis positive group (n). The proportion of infiltrating type was also high, histologic type was adenocarcinoma, differentiation degree was middle and low differentiation, stage 鈪，

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