子宫肉瘤术后复发的临床研究

发布时间：2018-03-20 05:33

本文选题：子宫肉瘤　切入点：复发　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:分析子宫肉瘤术后复发患者的临床特征、影响因素及预后情况。研究方法:收集1999年12月至2013年12月期间山东大学齐鲁医院收治的子宫肉瘤患者的临床资料,105例符合入组标准,其中复发者49例。与同期未复发者(56例)对比,分析子宫肉瘤复发患者的临床特征、复发部位、复发时间、复发相关因素、复发后治疗及预后情况。应用SPSS 19.0软件进行统计学分析。所有检验方法认为P0.05有统计学差异。结果:1.复发部位:单纯局部复发率为36.73%,单纯远处转移率为42.85%,局部复发合并远处转移率为20.41%。局部复发患者的5年死亡率为66.1%,远处转移患者的5年死亡率为85.7%,局部复发合并远处转移患者的5年死亡率90.0%,有统计学差异(P0.05)。2.复发时间:平均复发时间20.67±23.77月,中位复发时间12.00月。2年内复发率为63.27%,2～5年复发率为24.29%,5年以上复发率12.24%。且不同复发时间的死亡率有统计学差异(P0.05)。3.病理特点:①Ⅰ期、Ⅱ期、Ⅲ期与Ⅳ期复发率分别为28.4%、57.1%、88.9%及100%,差异有统计学意义(P0.05)。②子宫平滑肌肉瘤、子宫内膜间质肉瘤、子宫腺肉瘤和未分化肉瘤复发率分别为56.8%、38.3%、27.3%和100%,差异有统计学意义(P0.05)。③全组有60例患者行淋巴结清扫术,其中复发组27例,未复发组33例。复发组淋巴结转移率为7.4%,未复发组淋巴结转移率为6.1%,无统计学差异(P0.05)。④肿瘤最大直径5cm的复发率(45.12%)显著高于直径≤5cm的复发率(14.81%),差异有统计学意义(P=0.002)。4.手术范围:①58例行子宫切除+双侧附件切除+盆腔淋巴结清扫术士腹主动脉旁淋巴结清扫术,29例行全子宫切除+双侧附件/单侧附件切除术,12例行全子宫切除术/全子宫+双侧输卵管切除术,4例行单纯肿瘤病灶切除术。2例患者具体手术方式不详。复发率分别为:43.1%、44.8%、58.3%及50%。各手术范围对比,复发率无统计学差异(P0.05)。②以是否行淋巴结清扫术分为两组,复发率无统计学差异(P0.05)。5.术后辅助治疗:术后化疗55例,术后未辅助治疗37例,术后大剂量孕激素治疗9例,术后放疗3例,术后放化疗1例。各治疗方法比较,复发率无统计学差异(P=0.157)。6.复发后治疗:49例复发患者,以复发后是否行手术治疗分为手术组和非手术组。①手术组5年死亡率57.1%,非手术组5年死亡率89.5%,差异有统计学意义(P=0.022)。②复发后平均生存时间24.1 ±31.25月,中位生存时间10月。手术组复发后平均生存时间39.43±39.95月,中位生存时间27月,非手术组平均生存时间16.21 ± 16.83月,中位生存时间10月。差异有统计学意义(P=0.01)。7.单因素分析示,年龄、分期、病理类型及肿瘤大小是影响复发的主要因素;多因素分析示,年龄和分期是影响复发的独立危险因素。对局部复发和远处转移分别进行分析,年龄和分期是局部复发和远处转移的独立危险因素。8.复发患者预后的影响因素分析示,年龄、复发时间及复发后治疗是影响复发患者预后的独立危险因素。结论:1.子宫肉瘤易复发,局部复发率及远处转移率均较高。2.复发多发生于2年内,复发时间越早,预后越差。3.年龄及分期是子宫肉瘤复发的独立危险因素。4.年龄越大、复发时间越早是影响复发患者预后的独立危险因素,复发后手术治疗是复发患者预后的保护因素。5.子宫肉瘤恶性程度高,复发转移发生早,预后差,亟待行之有效的辅助治疗方案用于预防复发及改善预后。
[Abstract]:Objective: to analyze the clinical characteristics of patients with postoperative recurrence of uterine sarcoma, influencing factors and prognosis. Methods: the clinical data collected from December 1999 to December 2013 at the Qilu Hospital of Shandong University from uterine sarcoma patients, 105 patients met the inclusion criteria, including 49 cases of recurrence. Compared with non recurrence group (56 cases) comparative analysis. The clinical characteristics of patients with uterine sarcoma recurrence site of recurrence, recurrence time, recurrence related factors, treatment and prognosis after recurrence. SPSS 19 software was used for statistical analysis. All test methods that P0.05 there were significant differences. Results: 1. sites of recurrence: simple local recurrence rate was 36.73%, only the distant metastasis rate was 42.85%, the rate of transfer local recurrence and distant recurrence of 20.41%. patients 5 year mortality rate was 66.1%, distant metastasis 5 years mortality rate was 85.7%, local recurrence and distant metastasis In 5 years the mortality rate was 90%, there was significant difference (P0.05).2. recurrence time: the mean recurrence time was 20.67 + 23.77 months, the median time to relapse was 12 months.2 years, the recurrence rate was 63.27%, the 2~5 year recurrence rate was 24.29%, there were significant differences in the 5 years recurrence rate of 12.24%. and different time of recurrence (P0.05 death rate.3. features: 1) the pathological stage I, II, III and IV recurrence rates were 28.4%, 57.1%, 88.9% and 100%, the difference was statistically significant (P0.05). The leiomyosarcoma of the uterus, endometrial stromal sarcoma, uterine sarcoma and undifferentiated flesh tumor recurrence rates were 56.8%, 38.3%, 27.3% and 100%, the difference was statistically significant (P0.05). The whole group of 60 patients underwent lymph node dissection, the recurrence group of 27 cases and 33 non recurrent cases. The recurrence rate of lymph node metastasis was 7.4%, recurrence rate of lymph node metastasis was 6.1%, there was no significant difference (P0.05) of the tumor. Maximum diameter Size of the recurrence rate of 5cm (45.12%) was significantly higher than the diameter is less than or equal to the recurrence rate of 5cm (14.81%), the difference was statistically significant (P=0.002).4. surgery: 58 cases underwent hysterectomy and bilateral oophorectomy and pelvic lymphadenectomy were paraaortic lymph node dissection, 29 cases underwent hysterectomy and bilateral / unilateral accessory appendix resection, 12 underwent hysterectomy / hysterectomy + bilateral tubal resection, 4 cases underwent tumor resection, the specific methods of operation of.2 patients is unknown. The recurrence rate was 43.1%, 44.8%, 58.3% and 50%. respectively the scope of operation contrast, recurrence rate had no significant difference (P0.05). According to whether for lymph node dissection were divided into two groups, the recurrence rate was no significant difference (P0.05) adjuvant therapy after.5. surgery: 55 cases of postoperative chemotherapy, without adjuvant therapy in 37 patients after operation, 9 cases of high dose progesterone treatment after surgery, 3 cases of postoperative radiotherapy and chemotherapy after operation in 1 cases. The treatment method The recurrence rate comparison, no statistically significant difference (P=0.157).6. recurrence after treatment: 49 cases of patients with recurrence, recurrence after surgical treatment were divided into operation group and non operation group. The operation group for 5 years the mortality rate was 57.1%, the non operation group 5 years the mortality rate was 89.5%, the difference was statistically significant (P=0.022). The average recurrence the survival time was 24.1 + 31.25 months, the median survival time of recurrence after surgery group in October. The average survival time was 39.43 + 39.95 months, the median survival time was 27 months, the non operation group the average survival time was 16.21 + 16.83 months, the median survival time in October. The difference was statistically significant (P =0.01), age, stage of.7. the single factor, pathological type and tumor size were the main factors influencing recurrence; multivariate analysis showed that age and stage are the independent risk factors of recurrence. The local recurrence and distant metastasis were analyzed, the age and stage is local recurrence and distant metastasis The prognostic factors of patients with independent risk factors for the recurrence of.8. analysis showed that age, time to recurrence and recurrence after treatment were independent prognostic factors of recurrence. Conclusion: Patients with 1. uterine sarcoma recurrence, local recurrence rate and distant metastasis rate were high.2. recurrence occurred in 2 years, the recurrence time earlier, prognosis the difference of age and.3. staging were independent risk factors of recurrence of uterine sarcoma.4. older, earlier recurrence were independent prognostic factors of relapse, recurrence after surgery is a protective factor for prognosis of patients with recurrent uterine sarcoma.5. high degree of malignancy, recurrence and early metastasis, poor prognosis, to be effective auxiliary treatments to prevent recurrence and improve the prognosis.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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