發(fā)布時(shí)間：2018-01-08 07:02

  本文關(guān)鍵詞：77例上皮性卵巢癌預(yù)后相關(guān)因素分析　出處：《河北醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 上皮性卵巢癌 PR FOXM1 ERα ERβ 預(yù)后 殘留灶 生存分析

【摘要】：目的:觀察PR、FOXM1、ERα和ERβ在上皮性卵巢癌的表達(dá)情況,探討上皮性卵巢癌患者的發(fā)病年齡、術(shù)后輔助化療、病理組織類型、FIGO分期、淋巴結(jié)和闌尾轉(zhuǎn)移、手術(shù)殘留病灶的大小及PR、FOXM1、ERα和ERβ的表達(dá)等因素對(duì)預(yù)后的影響。方法:免疫組織化學(xué)方法檢測77例人卵巢癌組織中PR、FOXM1、ERα和ERβ的表達(dá)情況。通過門診及電話隨訪,了解患者出院后的診治及生存情況�；仡櫺苑治龌颊叩陌l(fā)病年齡、術(shù)后輔助化療、病理組織類型、FIGO分期、淋巴結(jié)和闌尾是否轉(zhuǎn)移、手術(shù)殘留病灶的大小及PR、FOXM1、ERα和ERβ的表達(dá)等因素對(duì)患者預(yù)后的影響。應(yīng)用SPSS 13.0軟件進(jìn)行統(tǒng)計(jì)學(xué)處理,采用Kaplan-Meier法進(jìn)行單因素分析,應(yīng)用Log-rank法對(duì)生存率差異進(jìn)行檢驗(yàn)(P0.05);Cox回歸模型進(jìn)行多因素分析(P0.05)。結(jié)果:1 77例上皮性卵巢癌患者中,發(fā)病年齡50歲組患者平均生存時(shí)間67.875個(gè)月,95%CI[53.239,82.510];≥50歲組患者平均生存時(shí)間43.895個(gè)月,95%CI[34.297,53.492],兩組患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.008)。術(shù)后輔助化療0次患者的平均生存時(shí)間為29.314個(gè)月,95%CI[18.425,40.202];6次化療的患者平均生存時(shí)間為41.949個(gè)月,95%CI[33.532,50.366];≥6次化療的患者平均生存時(shí)間為69.937個(gè)月,95%CI[55.436,84.437],三組患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.001)。低級(jí)別漿液性卵巢癌患者的平均生存時(shí)間92.644個(gè)月,95%CI[63.658,121.630];高級(jí)別漿液性卵巢癌患者的平均生存時(shí)間47.044個(gè)月,95%CI[39.398,54.690];粘液性卵巢癌患者的平均生存時(shí)間49.000個(gè)月,95%CI[8.074,89.926];子宮內(nèi)膜樣卵巢癌患者的平均生存時(shí)間43.900個(gè)月,95%CI[34.626,53.174];透明細(xì)胞卵巢癌患者的平均生存時(shí)間17.600個(gè)月,95%CI[13.429,21.771],五組不同病理組織類型的卵巢癌患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.001)。Ⅰ期卵巢癌患者的平均生存時(shí)間67.800個(gè)月,95%CI[40.653,94.947];Ⅱ期卵巢癌患者的平均生存時(shí)間16.000個(gè)月,95%CI[2.579,29.421];Ⅲ期卵巢癌患者的平均生存時(shí)間55.660個(gè)月,95%CI[45.408,65.912];Ⅳ期卵巢癌患者的平均生存時(shí)間29.778個(gè)月,95%CI[17.301,42.255],四組不同F(xiàn)IGO分期的卵巢癌患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.004)。淋巴結(jié)未轉(zhuǎn)移組的平均生存時(shí)間66.339個(gè)月,95%CI[52.747,79.931];淋巴結(jié)轉(zhuǎn)移組的平均生存時(shí)間40.134個(gè)月,95%CI[30.220,50.049],兩組患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.003)。闌尾未轉(zhuǎn)移組的平均生存時(shí)間59.585個(gè)月,95%CI[47.477,71.694];闌尾轉(zhuǎn)移組的平均生存時(shí)間38.950個(gè)月,95%CI[31.574,46.327],兩組患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.032)。腫瘤細(xì)胞減滅術(shù)中殘留灶1cm組平均生存時(shí)間66.723個(gè)月,95%CI[55.234,78.203];術(shù)中殘留灶≥1cm組平均生存時(shí)間30.004個(gè)月,95%CI[22.418,37.590],兩組患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.001)。2 77例卵巢癌石蠟標(biāo)本中,PR陰性表達(dá)68例(88.31%),陽性表達(dá)9例(11.69%);FOXM1陰性表達(dá)17例(22.08%),陽性表達(dá)60例(77.92%);ERα陰性表達(dá)42例(54.55%),陽性表達(dá)35例(45.45%);ERβ陰性表達(dá)20例(25.97%),陽性表達(dá)57例(74.03%)。PR陰性表達(dá)組平均生存時(shí)間48.971個(gè)月,95%CI[40.235,57.707];陽性表達(dá)組平均生存時(shí)間78.639個(gè)月,95%CI[52.192,105.086],兩組患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.046)。FOXM1陰性表達(dá)組平均生存時(shí)間38.208個(gè)月,95%CI[23.607,52.809];陽性表達(dá)組平均生存時(shí)間54.128個(gè)月,95%CI[44.570,63.686],兩組患者的生存率差異沒有統(tǒng)計(jì)學(xué)意義(P=0.474)。ERα陰性表達(dá)組平均生存時(shí)間49.493個(gè)月,95%CI[38.419,60.568];陽性表達(dá)組平均生存時(shí)間56.447個(gè)月,95%CI[42.290,70.603],兩組患者的生存率差異沒有統(tǒng)計(jì)學(xué)意義(P=0.597)。ERβ陰性表達(dá)組平均生存時(shí)間38.126個(gè)月,95%CI[27.901,48.352];陽性表達(dá)組平均生存時(shí)間58.208個(gè)月,95%CI[47.027,69.390],兩組患者的生存率差異有統(tǒng)計(jì)學(xué)意義(P=0.043)。3多因素分析結(jié)果顯示上皮性卵巢癌的化療療程、淋巴結(jié)是否轉(zhuǎn)移、殘留灶的大小、ERβ的陽性表達(dá)是影響上皮性卵巢癌預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論:上皮性卵巢癌患者的發(fā)病年齡、術(shù)后輔助化療療程、病理組織類型、FIGO分期、淋巴結(jié)和闌尾轉(zhuǎn)移、殘留灶的大小及PR和ERβ的表達(dá)情況等因素與其預(yù)后密切相關(guān)。FOXM1和ERα的表達(dá)情況對(duì)上皮性卵巢癌的預(yù)后沒有影響。理想的腫瘤減滅術(shù)后,輔助規(guī)律的化療可顯著改善上皮性卵巢癌患者的預(yù)后;ERβ可作為其預(yù)后的標(biāo)記物。
[Abstract]:Objective: To observe the effect of PR, FOXM1, ER alpha and ER beta expression in epithelial ovarian cancer, to investigate the age of onset in patients with epithelial ovarian cancer, adjuvant chemotherapy, pathological type, FIGO staging, lymph node metastasis and the appendix surgery, residual size and PR, the lesions of FOXM1, ER alpha and ER the expression of beta and other factors on the prognosis. Methods: immunohistochemical method in 77 cases of human ovarian carcinoma PR, FOXM1 expression of ER alpha and ER beta. Through outpatient and telephone follow-up, understand the patients discharged from hospital after treatment and survival were retrospectively analyzed. The age of patients, postoperative adjuvant chemotherapy pathological type, FIGO staging, lymph node metastasis, and the appendix, the residual operation size and PR, the lesions of FOXM1, ER alpha and ER beta expression and other factors on the prognosis of the patients. The application of SPSS 13 software was used for statistical analysis, single factor analysis using the Kaplan-Meier method, should be To test the difference of survival rate by Log-rank method (P0.05); Cox regression model for multivariate analysis (P0.05). Results: 177 cases of epithelial ovarian cancer patients, age 50 years old group the mean survival time were 67.875 months, 95%CI[53.239,82.510] group of patients over 50 years old; average survival time was 43.895 months, 95%CI[34.297,53.492], statistically significant difference in survival rate between the two groups (P=0.008). Postoperative adjuvant chemotherapy in 0 patients with an average survival time of 29.314 months, 6 times of chemotherapy for patients with 95%CI[18.425,40.202]; the average survival time was 41.949 months, 95%CI[33.532,50.366] = 6; chemotherapy of patients with an average survival time was 69.937 months, 95%CI[55.436,84.437]. There is significant difference in survival rate between the three groups (P=0.001). The average survival time of low grade serous ovarian cancer patients for 92.644 months, 95%CI[63.658121.630]; high-grade serous egg The average survival time of ovarian cancer patients for 47.044 months, 95%CI[39.398,54.690]; the average survival time of mucinous ovarian cancer patients for 49 months, 95%CI[8.074,89.926]; the average survival time of endometrioid ovarian cancer patients for 43.900 months, 95%CI[34.626,53.174]; the average survival time of patients with clear cell ovarian cancer 17.600 months, 95%CI[13.429,21.771], there was statistical significance in ovarian cancer the survival rate of patients between the five groups of different pathological types (P=0.001). The average survival time of patients with ovarian cancer of stage 67.800 months, 95%CI[40.653,94.947]; the average survival time of patients with ovarian cancer stage 95%CI[2.579,29.421]; 16 months, the average survival time of patients with ovarian cancer stage III 55.660 months, the average survival time of 95%CI[45.408,65.912]; ovarian cancer patients with stage 95%CI[17.301,42.255], 29.778 months, four groups of different FIGO stage ovarian cancer patients The survival rate was statistically significant (P=0.004). The average survival time of the group without lymph node metastasis 66.339 months, 95%CI[52.747,79.931]; lymph node metastasis group the average survival time of 40.134 months, 95%CI[30.220,50.049] was statistically significant difference in survival rate between the two groups (P=0.003). The average survival time of appendectomy without metastasis group 59.585 July, 95%CI[47.477,71.694]; the average survival time of 38.950 months appendiceal metastasis group, 95%CI[31.574,46.327], was statistically significant difference in survival rate between the two groups (P=0.032). Cytoreductive surgery residual tumor 1cm group mean survival time of 66.723 months, 95%CI[55.234,78.203] = 1cm; tumor group average survival time of 30.004 months, the residual operation in 95%CI[22.418,37.590], there is significant difference in survival rate between the two groups (P=0.001.2) in 77 cases of ovarian carcinoma were PR negative expression in 68 cases (88.31%), positive list In 9 cases (11.69%); the negative expression of FOXM1 in 17 cases (22.08%), 60 cases (77.92%); the positive expression of ER alpha negative expression in 42 cases (54.55%), 35 cases (45.45%); the positive expression of ER beta expression was negative in 20 cases (25.97%), 57 cases were positive (74.03%) in.PR negative expression group average the survival time of 48.971 months, 95%CI[40.235,57.707] positive expression group; the average survival time of 78.639 months, 95%CI[52.192105.086] was statistically significant difference in survival rate between the two groups (P=0.046).FOXM1 negative expression group the average survival time of 38.208 months, 95%CI[23.607,52.809] positive expression group; the average survival time was 54.128 months, 95%CI[44.570,63.686], the survival rate between the two groups there was no statistical significance (P=0.474).ER alpha negative expression group the average survival time of 49.493 months, 95%CI[38.419,60.568] positive expression group; the average survival time was 56.447 months, 95%CI[42.290,70.603], the survival rate between the two groups There was no statistical significance (P=0.597).ER beta negative expression group average survival time of 38.126 months, 95%CI[27.901,48.352]; positive group average survival time was 58.208 months, 95%CI[47.027,69.390] was statistically significant difference in survival rate between the two groups (P=0.043).3 multivariate analysis showed that chemotherapy of epithelial ovarian cancer, lymph node metastasis. Residual tumor size, the expression of ER beta were independent prognostic factors of epithelial ovarian carcinoma. Conclusion: the age of onset in patients with epithelial ovarian cancer, adjuvant chemotherapy in the postoperative course, pathology type, FIGO staging, lymph node metastasis and the appendix, did not affect the expression of residual tumor size and PR and the expression of ER beta and other factors related to the prognosis of.FOXM1 and ER alpha on the prognosis of epithelial ovarian carcinoma. The ideal cytoreductive surgery and chemotherapy can significantly improve on the auxiliary rules The prognosis of patients with ovarian ovarian cancer; ER beta can be used as a marker for its prognosis.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R737.31

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本文編號(hào)：1396072