本文選題：宮頸癌　切入點：新輔助化療　出處：《山東大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：評價宮頸癌患者新輔助化療的近期療效及復(fù)發(fā)率、轉(zhuǎn)移率和生存率,分析影響療效的各種因素。 方法：計算機檢索PUBMED數(shù)據(jù)庫、萬方數(shù)據(jù)庫、中國知網(wǎng)及有關(guān)文章的參考文獻,手工檢索山東大學(xué)圖書館及濟南市第三人民醫(yī)院圖書館有關(guān)宮頸癌新輔助化療方面的期刊書籍和雜志。語種限英語和漢語,時間不限。試驗組初始治療方法為新輔助化療聯(lián)合手術(shù),對照組初始治療方法為單純手術(shù)。對收集的資料進行評價,剔除不符合本文研究目的或不合質(zhì)量要求的文章。對同質(zhì)的研究采用RevMan5.1軟件進行meta分析。以患者的臨床療效,術(shù)中及術(shù)后情況、化療毒副作用、術(shù)后病理(淋巴結(jié)轉(zhuǎn)移、宮旁浸潤、脈管癌栓、陰道切緣、宮頸深肌層浸潤)及復(fù)發(fā)率、轉(zhuǎn)移率及3年、5年生存率為療效觀察指標,計算各個研究的RR值,通過合并RR值比較新輔助化療組與對照組的臨床療效、術(shù)中及術(shù)后情況、化療毒副作用、術(shù)后病理(淋巴結(jié)轉(zhuǎn)移、宮旁浸潤、脈管癌栓、陰道切緣、宮頸深肌層浸潤)及復(fù)發(fā)率、轉(zhuǎn)移率及3年、5年生存率,并探討影響療效的各種因素。 結(jié)果：共有11個臨床試驗包括1332例病人符合納入標準,其中五個為RCT,六個CCT,CCT有1例根據(jù)患者分期、年齡及個人意愿分組,其余均未詳細描述分組方法,所有試驗均未提及是否采用盲法。結(jié)果顯示,新輔助化療聯(lián)合手術(shù)組較單純手術(shù)組：1.術(shù)中及術(shù)后情況手術(shù)時間差異有統(tǒng)計學(xué)意義(IV,-12.53,95%CI,[-18.09,-6.97],PO.0001)；術(shù)中出血量差異無統(tǒng)計學(xué)意義(IV,-15.88,95%CI,[-76,87,45.1],P=0.61)；術(shù)后尿潴留差異無統(tǒng)計學(xué)意義(RR,0.70,95%CI,[0.21,2.32],P=0.56)。2.病理改變手術(shù)切緣陽性率差異有統(tǒng)計學(xué)意義(RR,0.55,95%CI,[0.37,0.82], P=0.003);淋巴結(jié)轉(zhuǎn)移率差異有統(tǒng)計學(xué)意義(RR,0.51,95%CI,[0.38,0.70], P0.0001);宮旁浸潤率差異有統(tǒng)計學(xué)意義(RR,0.51,95%CI,[0.31,0.90], P=0.02);脈管間隙浸潤率差異有統(tǒng)計學(xué)意義(RR,0.41,95%CI,[0.29,0.56], P0.00001);3.總生存率3年生存率差異有統(tǒng)計學(xué)意義(RR,1.12,95%CI,[0.98,1.28],P=0.01)；5年生存率差異有統(tǒng)計學(xué)意義(RR,1.12,95%CI,[1.04,1.22], P=0.005);4.復(fù)發(fā)率差異有統(tǒng)計學(xué)意義(RR,0.57,95%CI,[0.34,0.97],P=0.04)；5.遠處轉(zhuǎn)移率差異有統(tǒng)計學(xué)意義(RR,0.37,95%CI,[0.17,0.82], P=0.01)。 結(jié)論：新輔助化療聯(lián)合手術(shù)治療和單純手術(shù)治療相比,可以縮短手術(shù)時間,但并不能減少術(shù)中出血量,不能減少術(shù)后尿潴留的發(fā)生率�？梢越档陀绊戭A(yù)后的病理危險因素發(fā)生率,包括陰道切緣陽性、淋巴結(jié)轉(zhuǎn)移、宮旁浸潤、脈管間隙浸潤,可以降低復(fù)發(fā)率和遠處轉(zhuǎn)移率,新輔助化療可以提高患者3年及5年生存率,本研究無法證明年齡、腫瘤直徑大小、分期、病理類型及分化、給藥途徑及化療方案對新輔助化療療效的影響。
[Abstract]:Objective: to evaluate the recent curative effect, recurrence rate, metastasis rate and survival rate of neoadjuvant chemotherapy in patients with cervical cancer. Methods: PUBMED database, Wanfang database, Chinese knowledge network and related articles were searched by computer. To manually search the journal books and magazines of Shandong University Library and Jinan third people's Hospital Library on neoadjuvant chemotherapy for cervical cancer. The initial treatment method in the experimental group was neoadjuvant chemotherapy combined surgery, while in the control group, the initial treatment method was simple surgery. The data collected were evaluated. RevMan5.1 software was used for meta analysis. The clinical effect, intraoperative and postoperative conditions, side effects of chemotherapy, postoperative pathology (lymph node metastasis, lymph node metastasis) were analyzed. Periuterine invasion, vascular tumor embolus, vaginal margin, deep cervical myometrial infiltration) and recurrence rate, metastasis rate, 3-year and 5-year survival rate were used as therapeutic indicators. RR values of each study were calculated. The clinical efficacy, intraoperative and postoperative conditions, side effects of chemotherapy, postoperative pathology (lymph node metastasis, periuterine infiltration, vascular carcinoma embolus, vaginal margin) were compared between neoadjuvant chemotherapy group and control group by combining RR values. The recurrence rate, metastasis rate and 3-and 5-year survival rate were investigated. Results: a total of 11 clinical trials including 1332 patients met the inclusion criteria, five of them were RCTs, and one of the six CCT patients was grouped according to the patient's stage, age and personal wishes. The rest did not describe the grouping method in detail. No mention was made of the use of the blind method. The results showed that, The operative time of neo-adjuvant chemotherapy combined operation group was significantly different than that of simple operation group (IV-12.53-95 CI, [-18.09U -6.97] PO.0001C; there was no significant difference in intraoperative bleeding volume (IV-15.888-95 CI, [-768745.1] P0.61; postoperative urinary retention was not statistically significant RR0.70595 CI, [0.21 鹵2.32] P0.566.32] P0.566.2.The pathological changes of the hands were not significant. There were significant differences in the positive rate of the resection margin, [0.37 鹵0.82], P0. 003; the difference of lymph node metastasis rate was statistically significant; the difference of lymph node metastasis rate was statistically significant. [0.38 鹵0.70], P0. 0001C; there was a significant difference in the periuterine infiltration rate between RR0. 51-95 CI, [0.31 鹵0. 90], P0. 02; there was significant difference in vascular interstitial infiltration rate between RR0. 495 CI, [0. 2929 0. 56], P0. 001 0. 3. The overall 3 year survival rate was significant. There were significant differences in survival rate between RRX 1.1295CI, [0.981.28] and 5-year survival rate (RRX 1.1295CI, [1.041.22] P = 0.0051CI). There were significant differences in recurrence rate between RR0.5795CII, [0.3440.97] P0.04Ci and distant metastasis rate (0.37795 CI, [0.170.82] P0. 01). Conclusion: neoadjuvant chemotherapy combined with surgery can shorten the operative time, but it can not reduce the amount of intraoperative bleeding. The incidence of postoperative urinary retention can not be reduced. It can reduce the incidence of pathological risk factors affecting prognosis, including vaginal margin positive, lymph node metastasis, periuterine infiltration, vascular space infiltration, and reduce recurrence rate and distant metastasis rate. Neoadjuvant chemotherapy can improve the 3-year and 5-year survival rate of patients. This study could not prove the influence of age, tumor diameter, stage, pathological type and differentiation, administration route and chemotherapy regimen on the efficacy of neoadjuvant chemotherapy.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33

【參考文獻】

相關(guān)期刊論文 前10條

1 劉弘揚;奈Z赯，

本文編號：1560751