本文關鍵詞： 早期宮頸腺癌 術后 預后分析　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景:宮頸癌在世界范圍內是除乳腺癌外導致女性發(fā)病和死亡最常見的惡性腫瘤,也是發(fā)病率最高的女性生殖系統(tǒng)惡性腫瘤。在發(fā)展中國家中,宮頸癌約占女性惡性腫瘤的24%,嚴重威脅婦女的健康、生命和生活質量。宮頸癌常見的病理類型有宮頸鱗癌、宮頸腺癌和腺鱗癌三種類型,其中宮頸腺癌的發(fā)病率近年來逐漸升高,且更趨向于年輕化。宮頸腺癌與宮頸鱗癌相比表現(xiàn)出不同的生物學特性,如宮頸腺癌較宮頸鱗癌發(fā)病隱匿,臨床表現(xiàn)及婦科檢查各異,術前易誤診、漏診,易影響診斷和治療方法的選擇,且宮頸腺癌對放療不如宮頸鱗癌敏感,預后較差。雖然目前許多研究者正在致力研究與宮頸腺癌預后有關的因素,但宮頸腺癌確切的預后因素尚未明確。因此研究宮頸腺癌的預后相關因素,從而指導臨床治療是非常有意義的。研究目的:研究早期宮頸腺癌(I B1-II A期)經(jīng)手術治療后患者的預后相關因素。研究方法:對我院2005年1月1日至2015年1月1日初治的80例早期宮頸腺癌患者(FIGO分期IB1期-IIA期)進行回顧性分析,該80例患者均行根治性子宮切除+雙附件切除+盆腔淋巴結清掃術,收集所有患者的臨床資料,包括人口學資料、臨床資料及隨訪信息等,觀察和記錄患者的無瘤生存期(disease-free survival,DFS)與總生存期(overall survival,OS)。對年齡、腫瘤分期、分化程度、腫瘤直徑、絕經(jīng)、淋巴結轉移、間質浸潤深度、LVSI、腫瘤標志物、累及附件、術前是否新輔助化療、術后是否行放化療、P16等因素進行統(tǒng)計分析,采用Kaplan-Meier法計算生存率,Log-rank檢驗進行單因素分析及各組生存率曲線分布比較,Cox回歸模型進行多因素分析,研究影響宮頸腺癌預后的因素。結果:回訪的80例早期宮頸腺癌患者發(fā)病最小年齡為29歲,最大發(fā)病年齡73歲,平均年齡為45.6歲,其中40-49歲的患者發(fā)病率最高,80例患者的生存時間為8-124個月,中位生存時間50個月,因宮頸腺癌死亡者10例(12.5%)。所回訪患者的3年生存率為90.5%,5年生存率為87.1%。單因素分析顯示:年齡、絕經(jīng)、臨床分期、腫瘤直徑、分化程度、淋巴結轉移、間質浸潤深度的生存率差異有統(tǒng)計學意義(P0.05)。Cox風險比例回歸模型對年齡、臨床分期、絕經(jīng)與否、分化程度、腫瘤直徑、間質浸潤深度、淋巴結轉移等因素進行多因素分析,結果顯示:間質浸潤深度、分化程度、絕經(jīng)是影響宮頸腺癌預后的獨立因素。結論:間質浸潤深度、分化程度、絕經(jīng)與否是影響早期宮頸腺癌術后預后的獨立因素。
[Abstract]:Background: cervical cancer is the most common malignant tumor in women except breast cancer, and it is also the most common malignant tumor in female reproductive system. Cervical cancer accounts for about 24% of female malignant tumors, which seriously threaten women's health, life and quality of life. The common pathological types of cervical cancer include cervical squamous cell carcinoma, cervical adenocarcinoma and adenosquamous carcinoma. The incidence of cervical adenocarcinoma gradually increased in recent years, and tend to be younger. Compared with cervical squamous cell carcinoma, cervical adenocarcinoma has different biological characteristics, such as cervical adenocarcinoma than cervical squamous cell carcinoma. The clinical manifestation and gynecological examination are different, preoperatively misdiagnosed, missed diagnosis, easy to affect the choice of diagnosis and treatment, and cervical adenocarcinoma is less sensitive to radiotherapy than cervical squamous cell carcinoma. Although many researchers are studying the factors related to the prognosis of cervical adenocarcinoma, the exact prognostic factors of cervical adenocarcinoma are not clear. Therefore, the prognostic factors of cervical adenocarcinoma are studied. Therefore, it is very meaningful to guide clinical treatment. Objective: to study the early stage I B 1-II A of cervical adenocarcinoma. Prognostic factors of patients undergoing surgical treatment. Methods: 80 cases of early cervical adenocarcinoma treated in our hospital from January 1st 2005 to January 1st 2015 were studied. FIGO stage: IB1 phase-IIA stage) were retrospectively analyzed. All the 80 patients underwent radical hysterectomy and double appendage resection of pelvic lymph node dissection. All the clinical data including demographic data clinical data and follow-up information were collected. The tumor-free survival time (DFSs) and total survival time (survival) of the patients were observed and recorded. For age, tumor staging, differentiation, tumor diameter, menopause, lymph node metastasis, interstitial infiltration depth of LVSIs, tumor markers, attachment, preoperative neoadjuvant chemotherapy. The survival rate was calculated by Kaplan-Meier method. Log-rank test was performed by univariate analysis and comparison of survival curve distribution among groups. Multivariate analysis was performed by Cox regression model. Results: the minimum age of 80 patients with early cervical adenocarcinoma was 29 years old and the maximum age was 73 years with an average age of 45.6 years. The survival time of 80 patients aged 40-49 years was 8-124 months, and the median survival time was 50 months. The 3-year survival rate was 90.5 and the 5-year survival rate was 87.1. Univariate analysis showed: age, menopause, clinical stage. The survival rates of tumor diameter, differentiation degree, lymph node metastasis, and depth of interstitial infiltration were significantly different from those of age, clinical stage, menopause or not. The degree of differentiation, the diameter of tumor, the depth of interstitial infiltration, lymph node metastasis and other factors were analyzed. The results showed that the depth of interstitial infiltration, the degree of differentiation. Conclusion: the depth of interstitial infiltration, the degree of differentiation and the menopause are independent factors influencing the prognosis of early cervical adenocarcinoma.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33

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