20例卵巢成熟性畸胎瘤恶变的临床分析

发布时间：2018-05-13 16:19

本文选题：卵巢成熟性畸胎瘤恶变 + 危险因素　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:探讨卵巢成熟性畸胎瘤恶变的危险因素和分析影响预后的相关因素,以提高对卵巢成熟性畸胎瘤恶变的认识,为其规范治疗和改善预后提供一定帮助。方法:将吉林大学第一医院2010年12月至2015年12月收治的20例卵巢成熟性畸胎瘤恶变患者设为研究组,随机抽取同期住院治疗的40例卵巢成熟性畸胎瘤患者为对照组,通过分析两组患者在年龄、肿瘤大小、影像学特点及肿瘤标志物方面的差异,了解卵巢成熟性畸胎瘤恶变的危险因素,并分析卵巢成熟性畸胎瘤恶变患者的年龄、肿瘤大小、肿瘤标志物、组织学类型及手术病理分期这些因素与预后的相关性。统计学方法:采用SPSS19.0进行描述性统计分析,单因素分析采用t检验、方差分析,计数资料采用c2检验。预后生存情况应用Kaplan-Meier法,p0.05有统计学意义。结果:1.研究组患者年龄为23~75岁,平均年龄为46.20±13.11岁;对照组患者年龄为9~57岁,平均年龄为30.75±11.76岁。两组比较p0.05,差异有统计学意义。2.研究组患者的肿瘤直径为5~16.1cm,平均直径为9.92±3.03cm;对照组患者的肿瘤直径为2~15.7cm,平均直径为6.57±3.18cm。两组比较p0.05,差异有统计学意义。3.两组患者的超声声像中均可见短线样或团块样回声,研究组超声提示肿瘤可见血流信号者8例,未见血流信号者12例,阳性率为40%;对照组超声提示肿瘤可见血流信号者5例,未见血流信号者35例,阳性率为12.5%。两组比较p0.05,差异有统计学意义。4.两组肿瘤标志物阳性率比较,研究组CA125阳性率为60%,CA199阳性率为57.1%,CEA阳性率为28.6%,AFP阳性率为6.7%,SCC-Ag的阳性率为28.6%;对照组CA125阳性率为17.5%,CA199阳性率为51.4%,CEA阳性率为0,AFP阳性率为2.6%,SCC-Ag的阳性率为0。两组CA125、CEA及SCC-Ag的阳性率比较p0.05,差异有统计学意义;两组CA199及AFP的阳性率比较p0.05,差异无统计学意义。5.20例卵巢成熟性畸胎瘤恶变患者以平均年龄46岁为分界,其中46岁以下9例,生存8例,死亡1例,生存率为88.9%;46岁以上11例,生存7例,死亡4例,生存率为63.6%。两组的生存率比较p0.05,差异无统计学意义。6.20例卵巢成熟性畸胎瘤恶变患者的肿瘤大小以中位数9cm为分界,其中9cm以下8例,生存7例,死亡1例,生存率为87.5%;9cm以上12例,生存8例,死亡4例,生存率为66.7%。两组的生存率比较p0.05,差异有统计学意义。7.20例卵巢成熟性畸胎瘤恶变患者以术前各肿瘤标记物的阴性与阳性结果为界,各分为两组,其中CA125阳性组患者12例,生存9例,死亡3例,生存率为75%,阴性组患者8例,生存6例,死亡2例,生存率为75%;CA199阳性组患者6例,生存4例,死亡2例,生存率为66.7%,阴性组患者8例,生存5例,死亡3例,生存率为62.5%;CEA阳性组患者4例,生存3例,死亡1例,生存率为75%,阴性组患者10例,生存6例,死亡4例,生存率为60%;AFP阳性组患者1例,生存1例,死亡0例,生存率为100%,阴性组患者14例,生存9例,死亡5例,生存率为64.3%;SCC-Ag阳性组患者4例,生存1例,死亡3例,生存率为25%,阴性组患者14例,生存12例,死亡2例,生存率为85.7%。其中SCC-Ag的阳性组与阴性组患者的生存率比较p0.05,差异有统计学意义;CA125、CEA、CA199及AFP的阳性组与阴性组患者的生存率比较p0.05,差异无统计学意义。8.20例卵巢成熟性畸胎瘤恶变患者中8例鳞癌患者中生存6例,死亡2例,生存率为75%;7例类癌患者中生存6例,死亡1例,生存率为85.7%;5例其他组织学类型中生存2例,死亡3例,生存率为60%。三组的生存率比较,p0.05,差异无统计学意义。9.本研究中卵巢成熟性畸胎瘤恶变的手术病理分期是根据FIGO(2000年)的原发性卵巢恶性肿瘤手术病理分期标准进行分期。Ⅰ期患者16例,生存15例,死亡1例,生存率为93.7%;Ⅱ期及Ⅲ期患者4例,均死亡,生存率为0;两组患者的生存率比较,P0.05,差异有统计学意义。结论:1、卵巢成熟性畸胎瘤恶变的危险因素包括年龄、肿瘤大小、超声提示肿瘤的血流信号及肿瘤标志物CA125、CEA及SCC-Ag,其中年龄及肿瘤大小与卵巢成熟性畸胎瘤恶变呈正相关,超声提示肿瘤存在血流信号及肿瘤标志物CA125、CEA及SCC-Ag阳性的卵巢成熟性畸胎瘤应警惕恶变可能。2、卵巢成熟性畸胎瘤恶变的预后相关因素包括肿瘤大小、肿瘤标志物SCC-Ag及手术病理分期,其中肿瘤直径大于9cm、肿瘤标志物SCC-Ag阳性及手术病理分期Ⅱ期及Ⅱ期以上者预后较差。
[Abstract]:Objective: To explore the risk factors of ovarian mature teratoma and to analyze the related factors that affect the prognosis of ovarian mature teratoma, in order to improve the understanding of ovarian mature teratoma, and to provide some help for its standardized treatment and improvement of prognosis. Methods: 20 cases of ovarian mature teratoma treated in No.1 Hospital of Jilin University from December 2010 to December 2015. 40 patients with mature teratoma of the ovary were randomly selected as the control group. The risk factors of ovarian mature teratoma in two groups were analyzed by analyzing the age, tumor size, imaging characteristics and tumor markers, and the malignant changes of ovarian mature teratoma were analyzed. The correlation between the age, tumor size, tumor markers, histological type and surgical pathological staging. Statistical methods: descriptive statistical analysis was carried out by SPSS19.0, t test, variance analysis, and C2 test were used for single factor analysis. Kaplan-Meier method was applied to the prognosis of survival, and P0.05 was statistically significant. Results: the age of the 1. study group was 23~75 years old, the average age was 46.20 + 13.11 years old, the control group was 9~57 years old and the average age was 30.75 + 11.76 years old. The two groups were compared with P0.05. The difference was statistically significant in the.2. study group, the diameter of the tumor was 5~16.1cm, the average diameter was 9.92 + 3.03cm; the tumor diameter of the control group was 2~15.7cm, The average diameter of the 6.57 + 3.18cm. two groups was compared with P0.05. The difference was statistically significant in.3. two groups of patients with short line or lump like echo. In the study group, 8 cases of blood flow signal were seen in the tumor, 12 cases of blood flow signal were not seen, the positive rate was 40%. The control group showed 5 cases of blood flow signal in tumor. No blood was found in the control group. Flow signal 35 cases, positive rate was 12.5%. two groups compared P0.05, the difference was statistically significant.4. two group of tumor markers positive rate comparison, the study group CA125 positive rate was 60%, CA199 positive rate was 57.1%, CEA positive rate was 28.6%, AFP positive rate was 6.7%, SCC-Ag positive rate was 28.6%, the control group CA125 positive rate was 17.5%, CA199 positive rate was 51.4%, CEA. The positive rate was 0, the positive rate of AFP was 2.6%, the positive rate of SCC-Ag was 0. two CA125, the positive rate of CEA and SCC-Ag was P0.05, the difference was statistically significant. The positive rate of CA199 and AFP in the two group was P0.05, and the difference was not statistically significant in.5.20 cases of ovarian mature teratoma with the average age of 46 years, among which 9 cases under 46 years of age were 8, and survival 8 was 8. For example, 1 cases of death, the survival rate was 88.9%, 11 cases above 46 years old, 7 cases of survival, 4 cases of death, survival rate of 63.6%. two group was P0.05, the difference was not statistically significant, the size of the tumor size of.6.20 cases of ovarian mature teratoma was demarcation with median 9cm, of which 8 cases below 9cm, 7 cases, 1 cases, survival rate 87.5%, and 9cm above 12 For example, 8 cases of survival, 4 cases of death, survival rate of group 66.7%. two, the survival rate was P0.05, the difference was statistically significant,.7.20 cases of ovarian mature teratoma with negative and positive results were divided into two groups, of which 12 cases in the CA125 positive group, 9 cases of survival, 3 cases of death, the survival rate of 75%, negative group suffering. There were 8 cases, 6 cases of survival, 2 cases of death, the survival rate was 75%, 6 cases of CA199 positive group, 4 cases of survival, 2 cases of death, 66.7% of the survival rate, 8 cases in negative group, 5 cases of survival, 3 cases of survival, survival rate of 62.5%, survival rates of 4 cases, survival rates, survival rates, survival rates, AFP Yang There were 1 cases in the sex group, 1 cases of survival and 0 cases of death, the survival rate was 100%, the negative group was 14, the survival was 9, the survival rate was 64.3%, the SCC-Ag positive group was 4, 1, 3, the survival rate was 25%, the survival rate was 14, the survival rate was 85.7%. and the survival rate of the positive and negative group of SCC-Ag was the survival rate. Compared with P0.05, the difference was statistically significant, the survival rate of CA125, CEA, CA199, AFP and negative group was P0.05, and there was no statistically significant difference between 8 cases of ovarian mature teratoma patients and 6 cases of squamous cell carcinoma, 2 cases died, and the survival rate was 75%; 7 cases of cancer patients survived, 1 cases died, and the survival rate was 85.7%. In 5 other histological types, 2 cases were survived, 3 cases died, survival rate was 60%. three, the survival rate was compared, P0.05, the difference was not statistically significant. The pathological staging of ovarian mature teratoma in this study was based on the pathological staging of primary ovarian malignant tumors in FIGO (2000). 16 cases of stage I patients were born. There were 15 cases of death, 1 cases of death, the survival rate was 93.7%, and 4 cases in stage II and stage III were all dead and the survival rate was 0. The survival rate of the two groups was compared, P0.05, the difference was statistically significant. Conclusion: 1, the risk factors of ovarian mature teratoma include age, tumor size, blood flow signal of tumor and tumor markers CA125, CEA and SCC-Ag Age and tumor size are positively related to ovarian mature teratoma malignancy. Ultrasound suggests that the tumor has a blood flow signal and a tumor marker CA125. CEA and SCC-Ag positive ovarian mature teratoma should be vigilant for the possible.2. The prognostic factors of ovarian mature teratoma include tumor size, tumor marker SCC-Ag, and the prognosis of ovarian mature teratoma. Surgical staging, with tumor diameter larger than 9cm, tumor marker SCC-Ag positive, and stage of surgery and stage II and stage II, had poor prognosis.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.31

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