大同市卵巢交界性肿瘤的临床病理特征及术后复发影响因素的研究

发布时间：2018-03-12 23:00

本文选题：卵巢交界性肿瘤　切入点：浆液性BOT　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:卵巢交界性肿瘤(BOT)患者的术后复发情况及对复发瘤的诊治成为BOT治疗中日益重要的环节,而目前临床上对此存在较多的争议,故本研究通过了解BOT的临床和病理特征并对BOT患者术后复发情况进行研究,探讨肿瘤本身的特性及治疗方法等对BOT预后的影响,以期对未来BOT的诊治提供新的思路。方法:收集2009年1月~2014年12月期间,在大同市4所三级医院(一医院、三医院、五医院和同煤集团总医院)接受治疗并经术后病理检查确诊的123例卵巢上皮性交界性肿瘤患者为研究对象。通过查阅病案资料收集一般人口学特征资料、临床病理特征资料及BOT术后复发可能的影响因素等资料,对研究对象的一般情况及肿瘤的病理分型等进行描述分析,并采用病例对照研究,对BOT术后复发进行相应的影响因素分析。结果:(1)本研究的123例卵巢交界性肿瘤患者的术后复发率为20.32%(25/123),具有明显的年龄相关性,复发组的平均年龄显著低于非复发组,差异有统计学意义(t=3.872,P0.001),复发者年龄多集中在15岁到35岁之间。(2)BOT患者的病理类型以浆液性BOT为主(56.9%),其次为黏液性BOT(35.8%),经分析显示不同的肿瘤类型之间复发率差异无统计学意义(P=0.708)。(3)临床分期中仅发现I期和II期BOT患者,其中以Ia、Ib为主。经分析,不同的临床分期BOT术后复发率不同,差异具有统计学意义(P0.001)。进一步根据临床分期做趋势卡方检验,发现随着临床分期的增高,BOT术后复发的风险逐渐增高(趋势2x=41.127,P0.001)。(4)对复发组与非复发组患者各单因素进行分析,其中肿瘤大小、临床分期、微乳头生长情况、间质微浸润情况和腹膜种植情况5个指标上差异有统计学意义;在BOT术后复发的多因素logistic回归分析中,只有年龄和临床分期两个变量进入回归方程,即在其他条件不变的情况下,与年龄为大于55岁患者相比,年龄小于25岁和在25~35岁年龄段的BOT患者其术后复发的风险分别增加28.59倍和12.75倍;在其他条件不变的情况下,与临床分期为Ia期患者相比,临床分期为Ib期、Ic期和II期的BOT患者其术后复发的可能性分别增加9.56、53.78与118.94倍。结论:卵巢交界性肿瘤患者的病理类型以浆液性BOT为主,其次为黏液性BOT。卵巢交界性肿瘤患者整体预后好,但具有明显的年龄相关性;同等条件下,年龄越小复发率越高。此外该疾病的术后复发还与肿瘤的大小、生长形式、范围以及临床分期具有相关性。临床分期级别越高,术后的复发率越高。
[Abstract]:Objective: the recurrence of ovarian borderline tumor and the diagnosis and treatment of recurrent tumor become more and more important in the treatment of BOT. In this study, we studied the clinical and pathological features of BOT and the recurrence of BOT patients, and discussed the influence of tumor characteristics and treatment methods on the prognosis of BOT. Methods: from January 2009 to December 2014, four tertiary hospitals (one hospital, three hospitals) in Datong city were collected. Five hospitals and Tongmei Group General Hospital) 123 cases of ovarian epithelial sexual intercourse borderline tumor, which were treated and confirmed by pathological examination after operation, were studied. The data of general demographic characteristics were collected by consulting the medical records. The clinical and pathological data and the factors influencing the recurrence after BOT were analyzed. The general situation of the subjects and the pathological classification of the tumor were analyzed, and the case-control study was used. Results the recurrence rate of 123 patients with borderline ovarian tumor in this study was 20.32% 25 / 123, which was significantly age-related, and the average age of recurrence group was significantly lower than that of non-recurrence group. The difference was statistically significant (P 0.001). The pathological types of recurrent patients between 15 and 35 years old were serous BOT, followed by mucous BOT35.8T. There was no statistical difference in recurrence rate among different tumor types. In clinical stage, only stage I and stage II BOT patients were found. The recurrence rate of BOT patients with different clinical stages was different, and the difference was statistically significant (P 0.001). The trend chi-square test was done according to the clinical stages. It was found that with the increase of clinical staging, the risk of recurrence after bot was gradually increased (trend 2xX, 41.127, P 0.001, P 0.001). The single factors of recurrence group and non-recurrence group were analyzed, including tumor size, clinical stage and micronipple growth. In multivariate logistic regression analysis of recurrence after BOT, only two variables, age and clinical stage, entered the regression equation. That is, the risk of postoperative recurrence in patients under 25 years of age and in the 2535 age group was 28.59 times and 12.75 times higher than that in patients over 55 years of age, respectively, when other conditions remained unchanged; Compared with the patients with stage Ia, the recurrence rate of BOT patients with Ib stage I c and II stage increased by 9.56% 53.78 and 118.94 times respectively. Conclusion: serous BOT is the main pathological type of borderline ovarian tumors. The prognosis of borderline ovarian tumor is good, but it has obvious age correlation. The younger the age, the higher the recurrence rate under the same condition. In addition, the recurrence of the disease after operation is also related to the size and growth form of the tumor. The higher the grade of clinical staging, the higher the recurrence rate.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.31

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