内生颈管型宫颈癌的临床病理特征及预后因素分析

发布时间：2018-03-31 01:00

本文选题：内生颈管型宫颈癌　切入点：临床因素　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:内生颈管型宫颈癌是一种少见的宫颈癌类型,因其早期缺乏典型的临床症状,且病灶隐匿,临床上常易漏诊,本研究拟通过比较内生颈管型宫颈癌与非内生颈管型宫颈癌的临床病理资料并对两者进行预后分析,来探讨内生颈管型宫颈癌的临床病理特征及预后影响因素。以期达到早期识别,积极治疗,从而提高内生颈管型宫颈癌预后的目的。方法:收集2008年8月1日至2011年8月30日在河北医科大学第四医院妇科行手术治疗的宫颈癌患者478例。筛选出内生颈管型宫颈癌患者53例,非内生颈管型宫颈癌患者425例,比较两者临床病理特征的差异,并对两者的预后进行单因素及多因素分析。结果:1与非内生颈管型宫颈癌相比,内生颈管型宫颈癌确诊年龄≥50岁、一级亲属中有宫颈癌家族史、术后追加治疗者所占比例高,差异有统计学意义(P0.05),而孕产次、临床症状、临床分期与非内生颈管型宫颈癌无明显差异。2内生颈管型宫颈癌中非鳞癌居多,更易发生颈管内口受侵、宫体受侵、深肌层浸润及宫旁受侵(P0.05),但在术后肿瘤直径、组织学分级、脉管瘤栓及淋巴结转移方面与非内生颈管型宫颈癌无明显差异。3内生颈管型宫颈癌与非内生颈管型宫颈癌5年生存率分别为78.0%,88.2%,差异有统计学意义(P=0.041)。4多因素分析发现,术后肿瘤直径为影响内生颈管型宫颈癌预后的独立危险因素。5单因素分析中,肿瘤直径大于4cm、深肌层浸润、脉管瘤栓、宫颈管内口受侵、宫旁受侵、淋巴结转移是影响非内生颈管型宫颈癌预后的相关危险因素,肿瘤直径、淋巴结转移是影响非内生颈管型宫颈癌预后的独立危险因素。6内生颈管型宫颈癌手术前后肿瘤直径的符合率为69.81%,术后肿瘤直径显著大于术前(P=0.001)。结论:1与非内生颈管型宫颈癌相比,内生颈管型宫颈癌患者被检出时年龄较大,术后常常需要接受辅助治疗。2内生颈管型宫颈癌非鳞癌所占比例较高,更常出现深肌层浸润、颈管内口受侵、宫体受侵、宫旁受侵。3内生颈管型宫颈癌预后较非内生颈管型宫颈癌差,且不易早期识别,因此需要加强对内生颈管型宫颈癌的识别,术后管理及随访。4术后肿瘤直径是影响内生颈管型宫颈癌预后的独立危险因素。5肿瘤直径、深肌层浸润、脉管瘤栓、宫颈管内口受侵、宫旁受侵、淋巴结转移是影响非内生颈管型宫颈癌预后的相关危险因素,肿瘤直径、淋巴结转移是影响非内生颈管型宫颈癌预后的独立危险因素。
[Abstract]:Objective: endogenetic cervical carcinoma is a rare type of cervical cancer. In this study, the clinicopathological data of endogenetic cervical carcinoma and non-endogenetic cervical carcinoma were compared and their prognosis was analyzed. To explore the clinicopathological features and prognostic factors of endogenetic cervical carcinoma, in order to achieve early identification and active treatment. Objective: to improve the prognosis of endogenetic cervical carcinoma. Methods: 478 cases of cervical cancer treated by gynecological surgery from August 1, 2008 to August 30, 2011 were selected. 53 cases of cervical cancer, 425 cases of cervical cancer with non-endogenetic cervical canal type were studied. The difference of clinicopathological features between them was compared, and the prognosis of them was analyzed by univariate and multivariate analysis. Results compared with non-endogenetic cervical carcinoma, the ratio of 1 to 1 was higher than that of non-endogenetic cervical carcinoma. The diagnosis age of endogenetic cervical carcinoma was more than 50 years old, the family history of cervical cancer was found in the first degree relatives, the proportion of patients who received additional treatment after operation was high, the difference was statistically significant (P 0.05). There was no significant difference between clinical staging and non-endogenetic cervical carcinoma. 2 the non-squamous cell carcinoma of endogenetic cervical carcinoma was more likely to occur intrauterine invasion, uterine body invasion, deep myometrial invasion and pariuterine invasion (P0.05), but the tumor diameter and histological grade were observed after operation. There was no significant difference in vascular embolus and lymph node metastasis between endogenetic cervical carcinoma and non-endogenetic cervical carcinoma. 3 the 5-year survival rate of endogenetic cervical carcinoma and non-endogenetic cervical carcinoma was 78.0 and 88.2, respectively. The difference was statistically significant (P < 0.01). Tumor diameter was an independent risk factor for the prognosis of endogenetic cervical carcinoma. The diameter of the tumor was more than 4 cm, deep muscle infiltration, vascular tumor embolus, cervical canal invasion, para-uterine invasion. Lymph node metastasis is a risk factor related to the prognosis of non-endogenous cervical carcinoma. Lymph node metastasis is an independent risk factor for the prognosis of non-endogenetic cervical carcinoma... The coincidence rate of tumor diameter before and after operation for endogenetic cervical carcinoma is 69. 81, and the diameter of tumor after operation is significantly larger than that of preoperatively. Compared with tubular cervical cancer, The patients with cervical carcinoma of endogenetic cervical canal were older when they were detected. 2. The proportion of non-squamous cell carcinoma of cervical cancer of endogenetic cervical canal type was high, and the infiltration of deep muscle layer, the invasion of intraspinal orifice and the invasion of uterine body were more common. The prognosis of endogenetic cervical canal cervical carcinoma is worse than that of non-endogenetic cervical carcinoma, and it is not easy to identify early, so it is necessary to strengthen the recognition of endogenetic cervical duct cervical carcinoma. Postoperative management and follow-up were independent risk factors for the prognosis of endogenetic cervical carcinoma. 5. The diameter of tumor, the infiltration of deep muscle layer, the embolus of vascular tumor, the invasion of cervical canal orifice, and the invasion of periuterine. Lymph node metastasis is a risk factor related to the prognosis of non-endogenous cervical carcinoma. Tumor diameter and lymph node metastasis are independent risk factors for the prognosis of non-endogenetic cervical carcinoma.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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