發(fā)布時(shí)間：2018-02-09 21:06

  本文關(guān)鍵詞： 原發(fā)性輸卵管癌 病理類(lèi)型 術(shù)后殘留腫瘤大小 淋巴結(jié)轉(zhuǎn)移 預(yù)后　出處：《山東大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：研究目的:探究原發(fā)性輸卵管癌的臨床特點(diǎn)及影響預(yù)后因素。方法:收集2005年1月至2015年12月于山東大學(xué)齊魯醫(yī)院接受初始手術(shù)治療,病理診斷為原發(fā)性輸卵管癌的66例患者的臨床資料,回顧性分析其臨床特征。采用曼-惠特尼秩和檢驗(yàn)分析早期及晚期患者術(shù)前血清CA-125、CA-153、CA-199水平是否存在差異;用Kaplan-Meier法描繪生存曲線、COX比例風(fēng)險(xiǎn)模型進(jìn)行單因素及多因素生存分析,探討原發(fā)性輸卵管癌的預(yù)后因素。結(jié)果:患者平均年齡59.3歲(32-82歲),絕經(jīng)期婦女50例(占78.5%)。臨床表現(xiàn)為典型"三聯(lián)征"即陰道排液/流血、腹痛、盆腔腫塊者僅8例(12.1%),出現(xiàn)盆腔腫塊伴陰道排液/流血或腹痛"二聯(lián)征"者32例(48.5%),僅有其中一種臨床表現(xiàn)者21例(31.8%),無(wú)以上三種癥狀者5例(7.6%)。根據(jù)2013年國(guó)際婦產(chǎn)科聯(lián)合會(huì)(International Federation of Gynecology and Obstetrics,FIGO)手術(shù)病理分期:Ⅰ期14例,Ⅱ期9例,Ⅲ期41例,Ⅳ期2例。61例患者術(shù)前行血清CA-125檢測(cè),大于35U/ml者50例(82.0%),各期患者術(shù)前血清CA-125的陽(yáng)性率為:Ⅰ期 57.1%(8/14);Ⅱ 期 55.6%(5/9);Ⅲ 期 97.2%(35/36),5 例未查;Ⅳ期100%(2/2)。早期(Ⅰ-Ⅱ期)及晚期(Ⅲ-Ⅳ期)患者術(shù)前血清CA-125水平存在顯著差異(曼-惠特尼秩和檢驗(yàn)Z=-3.988,P0.001),而術(shù)前血清CA-199、CA-153水平的差異不顯著。術(shù)后病理根據(jù)WHO(2014)女性生殖器官腫瘤學(xué)分類(lèi)分為:漿液性癌62例,均為高級(jí)別,黏液性癌1例、透明細(xì)胞癌2例,高級(jí)別漿液性腺癌部分伴肉瘤樣分化1例。術(shù)后殘留腫瘤大小:無(wú)肉眼殘留者30例,殘留腫瘤直徑≤1cm者6例,殘余腫瘤直徑1cm者28例,未知?dú)埩裟[瘤大小者2例。61例患者術(shù)后接受TP(紫杉醇+順鉑)/TC(紫杉醇+卡鉑)/PC(順鉑+環(huán)磷酰胺)方案化療,其中≥6療程者45例。25例患者在隨訪過(guò)程中觀察到復(fù)發(fā),中位復(fù)發(fā)時(shí)間為末次化療后12月(8-48月)。66例患者中位生存時(shí)間為48月,術(shù)后3年生存率為62.5%,5年生存率為35.6%。FIGO各期患者5年生存率分別為:Ⅰ 期 77.1%、Ⅱ 期 42.3%、Ⅲ 期 23.9%、Ⅳ 期 0(Log rank 檢驗(yàn),P0.001)。經(jīng)COX多因素回歸分析,殘余腫瘤大小(HR=3.867,P=0.049)、病理類(lèi)型(HR=19.024,P=0.023)及淋巴結(jié)是否轉(zhuǎn)移(HR=0.167,P=0.024)是影響原發(fā)性輸卵管癌患者總生存期的獨(dú)立預(yù)后因素。結(jié)論:原發(fā)性輸卵管癌多見(jiàn)于絕經(jīng)期婦女,臨床表現(xiàn)無(wú)特異性,多伴有血清CA-125升高,且CA-125水平與手術(shù)病理分期相關(guān)。最常見(jiàn)的組織學(xué)類(lèi)型為高級(jí)別漿液性癌,治療方式主要為手術(shù)輔以術(shù)后化療。組織學(xué)類(lèi)型、淋巴結(jié)是否轉(zhuǎn)移及殘留腫瘤大小與患者的預(yù)后密切相關(guān)。
[Abstract]:Objective: to investigate the clinical characteristics and prognostic factors of primary fallopian tube carcinoma. Methods: from January 2005 to December 2015, the patients received initial surgical treatment in Qilu Hospital, Shandong University. The clinical data of 66 patients with primary fallopian tube carcinoma diagnosed by pathology were analyzed retrospectively. The serum CA-125 CA-153 CA-199 levels in early and late stage patients were analyzed by Mann-Whitney rank sum test. Kaplan-Meier method was used to describe the survival curve and Cox proportional risk model was used to analyze the survival of single factor and multiple factors. To investigate the prognostic factors of primary fallopian tube carcinoma. Results: the mean age of the patients was 59.3 years old or 32-82 years old, 50 cases of menopausal women (78.5%). The clinical manifestations were typical "triple sign" (vaginal effusion / bleeding, abdominal pain). There were only 8 cases of pelvic mass with vaginal effusion / bleeding or abdominal pain. There were 32 cases of pelvic mass with vaginal effusion / bleeding or abdominal pain "duplex sign". There were only 21 cases with one clinical manifestation, 21 cases with 31. 8% and 5 cases without the above three symptoms. According to the 2013 International Federation of Obstetrics and Gynecology, the International Federation of Gynecology and Obstetrics and Obstetrics and Gynaecology and Obstetrics and Gynecology and Obstetrics and Gynecology. Federation of Gynecology and stetrics Figo: 14 cases with stage 鈪，

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