影響Ⅰb2-Ⅱb期宮頸癌新輔助化療近期療效的相關(guān)因素分析
發(fā)布時(shí)間：2018-08-12 18:19
【摘要】：目的:探討影響Ib2-IIb期宮頸癌新輔助化療近期療效的相關(guān)因素。方法:回顧性分析2010年6月至2016年7月間就診于大連醫(yī)科大學(xué)附屬第二醫(yī)院和大連市婦產(chǎn)醫(yī)院婦產(chǎn)科患者的相關(guān)臨床資料,所有患者均經(jīng)病理檢查證實(shí)為宮頸癌且住院接受新輔助化療(NACT)治療。根據(jù)患者的病理類(lèi)型、病理分級(jí)、臨床分期、化療方案、化療療程、宮頸癌組織血流情況等不同因素進(jìn)行分組。對(duì)比化療前后宮頸腫塊大小變化,按照WHO(World Health Organization,世界衛(wèi)生組織)實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)統(tǒng)計(jì)各組完全緩解、部分緩解、無(wú)變化、進(jìn)展等例數(shù),根據(jù)公式總例數(shù)部分緩解例數(shù))(完全緩解例數(shù)有效率??(10)(28)100%計(jì)算有效率。并對(duì)所得數(shù)據(jù)行多因素非線性二分類(lèi)logistic回歸分析。結(jié)果:1.病理類(lèi)型:鱗癌組共85例,有效率為70.6%,包括:完全緩解(CR)5例,部分緩解(PR)63例,無(wú)變化(NC)14例,進(jìn)展(PD)3例;腺癌組共10例,有效率為10%,包括:PR 1例,NC 6例,PD 3例;其他組共4例,有效率為25%,包括:PR 1例,NC 1例,PD 2例,其病理類(lèi)型為腺鱗癌、乳頭狀鱗癌、神經(jīng)內(nèi)分泌癌;鱗癌對(duì)新輔助化療近期療效的影響明顯高于腺癌及其他病理類(lèi)型,差別有統(tǒng)計(jì)學(xué)意義(p=0.000)。2.病理分級(jí):I級(jí)組共18例,有效率為77.8%,包括:CR 2例,PR 12例,NC 4例;II級(jí)組共42例,有效率為71.4%,包括:CR 3例,PR 27例,NC 8例,PD 4例;III級(jí)組共39例,有效率為66.7%,包括:PR 26例,NC 9例,PD 4例。各組患者行NACT治療后有效率差別無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。3.臨床分期:Ib2期組共22例,有效率72.2%,包括:CR 2例,PR 14例,NC 6例;IIa期組共45例,有效率為73.3%,包括:CR 1例,PR 32例,NC 8例,PD 4例;IIb期組共32例,有效率為65.6%,包括:CR 2例,PR 19例,NC 7例,PD 4例;各組患者經(jīng)NACT治療后有效率差別無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。4.化療方案:TP組共60例,有效率73.3%,包括:CR 3例,PR 41例,NC 12例,PD 4例;TC組共25例,有效率72.0%,包括:CR 2例,PR 16例,NC 4例,PD 3例;DP組共7例,有效率57.1%,包括:PR 4例,NC 2例,PD 1例;DC組共5例,有效率40%,包括:NC 2例,PD 3例;其他組共2例,有效率50.0%,包括:PR 1例,NC 1例。TP組療效高于其他組,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。5.化療周期:1周期化療組共48例,有效率58.3%,包括:PR 28例,NC 15例,PD 5例。2周期化療組共51例,有效率82.4%,包括:CR 5例,PR 37例,NC 6例,PD 3例。比較兩組療效差異,2周期化療組的療效高于1周期化療組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。6.宮頸癌組織內(nèi)血流情況:血流豐富組共56例,有效率76.8%,包括:CR 4例,PR 34例,NC 12例,PD 6例;血流不豐富組共43例,有效率62.8%,包括:CR 1例,PR 23例,NC 15例,PD 4例;血流豐富的宮頸癌患者NACT近期療效高于血流不豐富的患者,但是療效無(wú)明顯差異(p0.05)。結(jié)論:1.病理類(lèi)型:鱗狀細(xì)胞癌的療效明顯高于其他病理類(lèi)型,病理類(lèi)型是影響NACT近期療效的獨(dú)立因素;2.病理分級(jí):病理分化程度不同的患者,近期化療效果差別無(wú)統(tǒng)計(jì)學(xué)意義。病理分級(jí)不是影響NACT近期療效的因素;3.臨床分期:臨床分期越高,治療有效率越低,但療效差異無(wú)統(tǒng)計(jì)學(xué)意義。臨床分期不是影響NACT近期療效的因素;4.化療方案:以鉑類(lèi)為基礎(chǔ)的各化療方案的有效率無(wú)明顯差別,化療方案不是影響新輔助化療近期療效的因素;5.化療療程:行1周期化療的患者有效率顯著低于2周期化療者,其差別有統(tǒng)計(jì)學(xué)意義。建議至少行2周期NACT化療。6.腫瘤內(nèi)血流情況:腫瘤組織內(nèi)血流豐富的患者有效率高于血流不豐富者,但差別無(wú)統(tǒng)計(jì)學(xué)意義。其不是影響新輔助化療療效的因素。
[Abstract]:Objective:To investigate the factors influencing the short-term efficacy of neoadjuvant chemotherapy for stage Ib2-IIb cervical cancer.Methods:The clinical data of patients who were admitted to the Second Affiliated Hospital of Dalian Medical University and the Obstetrics and Gynecology Hospital of Dalian Obstetrics and Gynecology Hospital from June 2010 to July 2016 were retrospectively analyzed. Patients were treated with neoadjuvant chemotherapy (NACT). The patients were grouped according to pathological type, pathological grade, clinical stage, chemotherapy regimen, chemotherapy course, blood flow of cervical cancer tissues and other factors. The changes of cervical mass size before and after chemotherapy were compared, and statistics were made according to WHO (World Health Organization) evaluation criteria of solid tumor efficacy. The total number of complete remission, partial remission, unchanged, progressive and other cases were calculated according to the formula (total number of partial remission cases?(10) (28) 100% effective rate). The data were analyzed by multivariate nonlinear binary logistic regression. Results: 1. Pathological type: 85 cases of squamous cell carcinoma, the effective rate was 70.6%, including: complete remission. There were 5 cases of CR, 63 cases of PR, 14 cases of NC and 3 cases of PD, 10 cases of adenocarcinoma, including 1 case of PR, 6 cases of NC and 3 cases of PD, and 4 cases of other groups, the effective rate was 25%, including 1 case of PR, 1 case of NC and 2 cases of PD. The pathological types were adenosquamous carcinoma, papillary squamous carcinoma and neuroendocrine carcinoma. The effect was significantly higher than that of adenocarcinoma and other pathological types, the difference was statistically significant (p = 0.000). 2. Pathological grading: 18 cases in grade I group, the effective rate was 77.8%, including: CR 2 cases, PR 12 cases, NC 4 cases; 42 cases in grade II group, the effective rate was 71.4%, including: CR 3 cases, PR 27 cases, NC 8 cases, PD 4 cases; 39 cases in grade III group, the effective rate was 66.7%, including: PR 26 cases, NC 9 cases, PD. Clinical staging: Ib2 group 22 cases, effective rate 72.2%, including: CR 2 cases, PR 14 cases, NC 6 cases; III group 45 cases, effective rate 73.3%, including: CR 1 case, PR 32 cases, NC 8 cases, PD 4 cases; III group 32 cases, effective rate 65.6%, including: CR 2 cases, PR 19 cases, NC 7 cases, P There was no significant difference in the effective rate among the three groups (p0.05). 4. Chemotherapy regimen: TP group 60 cases, effective rate 73.3%, including: CR 3 cases, PR 41 cases, NC 12 cases, PD 4 cases; TC group 25 cases, effective rate 72.0%, including: CR 2 cases, PR 16 cases, NC 4 cases, PD 3 cases; DP group 7 cases, effective rate 57.1%, including: PR 4 cases, NC2 cases, PD 1 cases; DC group 5.1%. The effective rate was 40%, including 2 cases of NC, 3 cases of PD, 2 cases of other groups, the effective rate was 50.0%, including 1 case of PR, 1 case of NC. The curative effect of TP group was higher than that of other groups, the difference was not statistically significant (p0.05). 5. Chemotherapy cycle: 48 cases in one cycle chemotherapy group, the effective rate was 58.3%, including: PR 28 cases, NC 15 cases, PD 5 cases in 5.2 cycle chemotherapy group, the effective rate was 82.4%, including: CR 5 cases, PR. There were 37 cases, 6 cases of NC and 3 cases of PD. The curative effect of 2-cycle chemotherapy group was higher than that of 1-cycle chemotherapy group, and the difference was statistically significant (p0.05). 6. Blood flow in cervical cancer tissues: 56 cases of rich blood flow group, effective rate 76.8%, including: CR 4 cases, PR 34 cases, NC 12 cases, PD 6 cases; 43 cases of low blood flow group, effective rate 62.8%, including: CR 1 case, P Conclusion: 1. Pathological type: the curative effect of squamous cell carcinoma is significantly higher than other pathological types, pathological type is an independent factor affecting the short-term efficacy of NACT; 2. Pathological classification: pathological differentiation process Pathological grading is not a factor affecting the short-term efficacy of NACT; 3. Clinical staging: the higher the clinical stage, the lower the treatment efficiency, but there is no significant difference in efficacy. Clinical staging is not a factor affecting the short-term efficacy of NACT; 4. Chemotherapy regimen: platinum-based chemotherapy. There was no significant difference in the efficacy of the regimen, and the chemotherapy regimen was not a factor affecting the short-term efficacy of neoadjuvant chemotherapy. 5. Chemotherapy regimen: The effective rate of patients receiving one cycle chemotherapy was significantly lower than that of patients receiving two cycles chemotherapy, the difference was statistically significant. Efficiency was higher than that of patients with insufficient blood flow, but the difference was not statistically significant.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.33
本文編號(hào)：2179901
[Abstract]:Objective:To investigate the factors influencing the short-term efficacy of neoadjuvant chemotherapy for stage Ib2-IIb cervical cancer.Methods:The clinical data of patients who were admitted to the Second Affiliated Hospital of Dalian Medical University and the Obstetrics and Gynecology Hospital of Dalian Obstetrics and Gynecology Hospital from June 2010 to July 2016 were retrospectively analyzed. Patients were treated with neoadjuvant chemotherapy (NACT). The patients were grouped according to pathological type, pathological grade, clinical stage, chemotherapy regimen, chemotherapy course, blood flow of cervical cancer tissues and other factors. The changes of cervical mass size before and after chemotherapy were compared, and statistics were made according to WHO (World Health Organization) evaluation criteria of solid tumor efficacy. The total number of complete remission, partial remission, unchanged, progressive and other cases were calculated according to the formula (total number of partial remission cases?(10) (28) 100% effective rate). The data were analyzed by multivariate nonlinear binary logistic regression. Results: 1. Pathological type: 85 cases of squamous cell carcinoma, the effective rate was 70.6%, including: complete remission. There were 5 cases of CR, 63 cases of PR, 14 cases of NC and 3 cases of PD, 10 cases of adenocarcinoma, including 1 case of PR, 6 cases of NC and 3 cases of PD, and 4 cases of other groups, the effective rate was 25%, including 1 case of PR, 1 case of NC and 2 cases of PD. The pathological types were adenosquamous carcinoma, papillary squamous carcinoma and neuroendocrine carcinoma. The effect was significantly higher than that of adenocarcinoma and other pathological types, the difference was statistically significant (p = 0.000). 2. Pathological grading: 18 cases in grade I group, the effective rate was 77.8%, including: CR 2 cases, PR 12 cases, NC 4 cases; 42 cases in grade II group, the effective rate was 71.4%, including: CR 3 cases, PR 27 cases, NC 8 cases, PD 4 cases; 39 cases in grade III group, the effective rate was 66.7%, including: PR 26 cases, NC 9 cases, PD. Clinical staging: Ib2 group 22 cases, effective rate 72.2%, including: CR 2 cases, PR 14 cases, NC 6 cases; III group 45 cases, effective rate 73.3%, including: CR 1 case, PR 32 cases, NC 8 cases, PD 4 cases; III group 32 cases, effective rate 65.6%, including: CR 2 cases, PR 19 cases, NC 7 cases, P There was no significant difference in the effective rate among the three groups (p0.05). 4. Chemotherapy regimen: TP group 60 cases, effective rate 73.3%, including: CR 3 cases, PR 41 cases, NC 12 cases, PD 4 cases; TC group 25 cases, effective rate 72.0%, including: CR 2 cases, PR 16 cases, NC 4 cases, PD 3 cases; DP group 7 cases, effective rate 57.1%, including: PR 4 cases, NC2 cases, PD 1 cases; DC group 5.1%. The effective rate was 40%, including 2 cases of NC, 3 cases of PD, 2 cases of other groups, the effective rate was 50.0%, including 1 case of PR, 1 case of NC. The curative effect of TP group was higher than that of other groups, the difference was not statistically significant (p0.05). 5. Chemotherapy cycle: 48 cases in one cycle chemotherapy group, the effective rate was 58.3%, including: PR 28 cases, NC 15 cases, PD 5 cases in 5.2 cycle chemotherapy group, the effective rate was 82.4%, including: CR 5 cases, PR. There were 37 cases, 6 cases of NC and 3 cases of PD. The curative effect of 2-cycle chemotherapy group was higher than that of 1-cycle chemotherapy group, and the difference was statistically significant (p0.05). 6. Blood flow in cervical cancer tissues: 56 cases of rich blood flow group, effective rate 76.8%, including: CR 4 cases, PR 34 cases, NC 12 cases, PD 6 cases; 43 cases of low blood flow group, effective rate 62.8%, including: CR 1 case, P Conclusion: 1. Pathological type: the curative effect of squamous cell carcinoma is significantly higher than other pathological types, pathological type is an independent factor affecting the short-term efficacy of NACT; 2. Pathological classification: pathological differentiation process Pathological grading is not a factor affecting the short-term efficacy of NACT; 3. Clinical staging: the higher the clinical stage, the lower the treatment efficiency, but there is no significant difference in efficacy. Clinical staging is not a factor affecting the short-term efficacy of NACT; 4. Chemotherapy regimen: platinum-based chemotherapy. There was no significant difference in the efficacy of the regimen, and the chemotherapy regimen was not a factor affecting the short-term efficacy of neoadjuvant chemotherapy. 5. Chemotherapy regimen: The effective rate of patients receiving one cycle chemotherapy was significantly lower than that of patients receiving two cycles chemotherapy, the difference was statistically significant. Efficiency was higher than that of patients with insufficient blood flow, but the difference was not statistically significant.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.33
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 于廣娟;;宮頸癌新輔助化療臨床應(yīng)用及預(yù)后影響因素[J];中國(guó)現(xiàn)代藥物應(yīng)用;2014年18期
2 盧建軍;張林燕;;紫杉醇與順鉑聯(lián)合化療治療宮頸癌的療效及與組織微血管和微淋巴管密度的關(guān)系[J];中國(guó)生化藥物雜志;2014年05期
3 劉翼;;子宮頸癌新輔助化療不同給藥途徑對(duì)療效的影響[J];實(shí)用癌癥雜志;2014年03期
4 雷慧;王建軍;童曉文;;宮頸癌中新輔助化療的意義[J];外科研究與新技術(shù);2013年03期
5 張佐炳;方葦;;彩色多普勒超聲檢測(cè)宮頸癌血流信號(hào)與腫瘤微血管密度關(guān)系的研究[J];中國(guó)臨床研究;2012年10期
6 熊瓊英;廣怡;劉成;;宮頸癌新輔助化學(xué)療法不同途徑的療效評(píng)價(jià)[J];現(xiàn)代婦產(chǎn)科進(jìn)展;2012年01期
7 張蓉;李斌;白萍;李洪君;李淑敏;吳令英;李巍;;紫杉醇聯(lián)合鉑類(lèi)在局部晚期宮頸癌新輔助化療中的應(yīng)用[J];中華腫瘤雜志;2011年08期
8 雷華江;岳軍;孫紅兵;;新輔助化療對(duì)宮頸癌組織中微血管密度表達(dá)的影響[J];西部醫(yī)學(xué);2011年05期
9 孫光偉;袁敏;程靜新;古力米熱·乃扎爾;楊樹(shù)法;劉墨;阿依帕夏;;兩種不同途徑新輔助化療治療局部晚期子宮頸癌的對(duì)比分析[J];新疆醫(yī)科大學(xué)學(xué)報(bào);2011年04期
10 姬紅;姚安梅;;兩種新輔助化療治療局部晚期宮頸癌的療效比較[J];現(xiàn)代腫瘤醫(yī)學(xué);2010年10期
，本文編號(hào)：2179901
本文鏈接：http://sikaile.net/shoufeilunwen/mpalunwen/2179901.html
最近更新
教材專(zhuān)著
