一、食管鳞癌相关多原发癌的临床特点总结分析二、超声内镜诊断食管癌N分期的研究

发布时间：2018-06-02 14:08

本文选题：食管鳞癌 + 多原发癌　；参考：《北京协和医学院》2015年博士论文

【摘要】：第一部分食管鳞癌相关多原发癌的临床特点总结与分析博士研究生：贺舜导师：王贵齐北京协和医学院中国医学科学院肿瘤医院[背景与目的]食管鳞状细胞癌是我国常见的恶性肿瘤,随着诊断技术的进步,越来越多的证据表明,食管鳞癌的发生往往是多病灶起源,同时伴有其他部位或器官的多原发现像,本研究总结我院一段时期内食管鳞癌的临床特点,分析食管鳞癌相关多原发癌的相关临床特征,为食管鳞癌的诊断及治疗提供依据与线索。[病例与方法]回顾分析中国医学科学院肿瘤医院2012年1月-2014年12月诊治的原发性食管鳞癌患者3104例。结合患者相关诊疗资料,按照多原发癌的诊断标准分为多原发癌组与非多原发癌组,分析比较两组的相关临床特点。[结果]11.9%的食管鳞癌发生了其他部位多原发癌；72.4%的多原发癌为同时性多原发癌；多原发癌组以头颈部多原发癌以及胃多原发癌最为常见,分别占6.8%及4.2%,其次为肺以及其他部位；头颈部多原发癌病例中食管多发病灶存在的比例要明显高于胃多原发癌及非多原发癌病例。[结论]食管鳞癌相关多原发癌是一种常见的临床现象,以同时性多原发癌为常见,部位又以头颈部及胃部多原发最为常见,而食管鳞癌中食管多发病灶的存在提示头颈部多原发癌发生的可能性高,了解这些临床特点有助于食管鳞癌相关多原发癌的诊断以及早期治疗。第二部分超声内镜诊断食管癌N分期的研究【背景与目的】食管癌的N分期不仅能够决定患者预后,对于患者选取何种治疗方式也起着决定性的作用。超声内镜(EUS)能够提供其他检查技术所不能提供的信息,在食管癌N分期方面具有一定的优势,但目前所报道的该诊断的准确性数据差异较大,同时缺少我国食管癌人群的相关数据。本研究目的在于寻找EUS判断淋巴结良恶性的最优诊断标准。[病例与方法]回顾性分析中国医学科学院肿瘤医院2014年1月-2014年6月间123例手术食管癌患者。记录术前超声内镜下所探及的淋巴结相关参数(①长径,②短径,③短长径比,④是否为低回声,边界是否光滑,⑤是否圆形或椭圆型,⑥是否低回声,⑦超声内镜下发现的淋巴结数目,⑧超声内镜诊断肿瘤的T分期,⑨淋巴结所在位置)。对比术前超声内镜探扫的淋巴结与术后清扫对应区域淋巴结病理诊断结果,应用统计学方法分析超声内镜探扫淋巴结各参数指标与淋巴结转移的关系,寻找判断淋巴结转移的最佳诊断标准。[结果]82.4%的超声内镜所探扫到的淋巴结能够与手术病理相对应。ROC曲线分析判断长径、短径以及超声内镜下发现淋巴结数目等3个参数指标诊断淋巴结良恶性的最佳临界值分别为 7.5mm,5.5mm以及2。单因素卡方检验提示有8个参数指标(长径7.5mm,短径5.5mmm,圆型,低回声,边界是否光滑,是否为病变旁淋巴结,超声内镜下发现淋巴结数2,超声内镜诊断为T3/4分期)用于判断淋巴结良恶性具有显著性意义。ROC曲线分析显示超声内镜改良标准(7个参数)在判断单个淋巴结良恶性准确性要优于常规标准(4个参数),AUC (0.801 VS 0.779);多因素logistic回归分析显示短径5.5mm,圆型,病变旁淋巴结,低回声是淋巴结转移独立的危险因素。改良标准与常规标准均取最佳临界值时(改良标准≥5个指标为阳性,常规标准≥3个指标为阳性),对食管癌N分期的诊断准确性分别为58%以及74.1%。改良标准要优于常规标准。[结论]超声内镜诊断食管癌淋巴结转移有较好的准确性,多个参数指标组合成的改良标准有助于提高淋巴结转移诊断的准确性。
[Abstract]:Part 1: a summary and analysis of the clinical characteristics of multiple primary carcinomas associated with squamous cell carcinoma of the esophagus: Dr. Ho Shun's tutor: the Cancer Hospital of the Chinese Academy of Medical Sciences, the Beijing Academy of Medical Sciences, Wang You Qi, [background and purpose] the squamous cell carcinoma of the esophagus is a common malignant tumor in China. With the progress of diagnostic techniques, more and more evidence shows the esophagus. The occurrence of squamous cell carcinoma is often the origin of multifocal lesions, accompanied by multiple original images of other parts or organs. This study summarizes the clinical features of squamous carcinoma of the esophagus in our hospital for a period of time and analyzes the clinical features of multiple primary cancers related to squamous carcinoma of the esophagus, providing evidence and clues for the diagnosis and treatment of squamous carcinoma of the esophagus. 3104 cases of primary squamous carcinoma of the esophagus were diagnosed and treated by the Cancer Hospital of the Chinese Academy of Medical Sciences in December -2014 January 2012. According to the related diagnosis and treatment data of the patients, the clinical characteristics of the two groups were analyzed and compared in accordance with the diagnostic criteria of the multiple primary cancer, and the related clinical features of the two groups were analyzed and compared. [results] the other parts of the esophageal squamous cell carcinoma occurred in other parts. Multiple primary carcinomas, 72.4% of multiple primary cancers were simultaneous multiple primary carcinomas; multiple primary carcinomas in the head and neck and gastric multiple primary cancers were the most common in the multiple primary cancer groups, accounting for 6.8% and 4.2% respectively, followed by the lung and other parts, and the presence of multiple primary cancers in the head and neck cases was significantly higher than that of the gastric multiple primary and non multiple primary cancers. [Conclusion] the multiple primary carcinoma of esophageal squamous cell carcinoma is a common clinical phenomenon. Multiple primary carcinoma is common with simultaneous multiple primary cancer. The most common sites are the head, neck and stomach. The presence of multiple esophageal foci in the squamous carcinoma of the esophagus suggests the high availability of multiple primary cancers in the head and neck. Understanding these clinical features helps the esophagus. Diagnosis and early treatment of squamous carcinoma related multiple primary carcinomas. Second partial endoscopic ultrasonography in the diagnosis of N staging of esophageal cancer [background and purpose] N staging of esophageal cancer not only determines the prognosis of the patients, but also plays a decisive role in the treatment of the patients. EUS can provide other examination techniques. The information provided has a certain advantage in the N staging of esophageal cancer, but the accuracy data of this diagnosis are very different at the present time, and there is a lack of relevant data in the population of esophageal cancer in our country. The purpose of this study is to find the optimal diagnostic criteria for EUS to judge the benign and malignant lymph nodes. 123 cases of surgical esophagus cancer patients in Hospital Cancer Hospital, January 2014 -2014 year June. The parameters of lymph node related to endoscopic ultrasonography were recorded (length diameter, short diameter, short diameter ratio, whether low echo, smooth boundary, round or elliptical, or not low echo, and the number of lymph nodes found under ultrasound endoscopy) The T staging of the tumor was diagnosed by endoscopic ultrasonography and the location of the lymph nodes). Compared with the pathological diagnosis of lymph nodes in the lymph nodes and the postoperative scavenging, the relationship between the parameters of the endoscopy and the lymph node metastasis was analyzed by the statistical method, and the best diagnosis of lymph node metastasis was found. [results] the optimal critical value of 3 parameters for diagnosing lymph nodes, such as the length of the length, the short diameter, and the number of lymph nodes found under endoscopic ultrasonography, was 7.5mm, 5.5mm and 2. single factor chi square tests suggested that there were 8 parameters in the lymph nodes detected by endoscopic ultrasonography of]82.4%. Indexes (long diameter 7.5mm, short diameter 5.5mmm, round type, low echo, smooth boundary, whether the lymph nodes are adjacent to the lesions, the number of lymph nodes 2 and T3/4 staging by endoscopic ultrasonography) is significant for the diagnosis of lymph node benign and malignant.ROC curve analysis shows that the improved standard of endoscopic ultrasonography (7 parameters) is to judge the single lymph node good The malignant accuracy was superior to the conventional standard (4 parameters), AUC (0.801 VS 0.779). The multiple factor Logistic regression analysis showed that the short diameter 5.5mm, the round type, the paramillary lymph nodes, the low echo were the risk factors for the independent lymph node metastasis. The improved standard and the conventional standard were all the best critical values (the improved standard > 5 indicators were positive, and the conventional standard was more than 3. The diagnostic accuracy of N staging for esophageal carcinoma is 58% and the standard of 74.1%. improvement is better than that of the conventional standard. [Conclusion] the diagnosis of lymph node metastasis of esophageal cancer by endoscopic ultrasonography is better. The improved standard of multiple parameter combinations is helpful to improve the accuracy of lymph node metastasis diagnosis.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.1

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一、食管鳞癌相关多原发癌的临床特点总结分析 二、超声内镜诊断食管癌N分期的研究

一、食管鳞癌相关多原发癌的临床特点总结分析二、超声内镜诊断食管癌N分期的研究