本文選題：宮頸癌　切入點(diǎn)：HPV　出處：《南方醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究背景:宮頸癌是常見的婦科惡性腫瘤之一,其嚴(yán)重威脅女性的健康與生命。近年來,隨著宮頸癌篩查及診斷技術(shù)的發(fā)展,手術(shù)操作方法的改進(jìn),越來越多的宮頸癌患者及時獲得診治。但在進(jìn)行了規(guī)范化治療后,仍然有部分宮頸癌患者出現(xiàn)復(fù)發(fā),而這是導(dǎo)致宮頸癌患者死亡的主要原因。因此,如何早期發(fā)現(xiàn)并有效預(yù)測宮頸癌復(fù)發(fā)及評估其預(yù)后,延長宮頸癌患者的生存時間,成為眾多臨床醫(yī)生關(guān)注的問題。宮頸癌治療后定期的臨床隨訪有助于早期發(fā)現(xiàn)宮頸癌復(fù)發(fā),提高宮頸癌患者生存率。但是,宮頸癌治療后隨訪的具體方案尚未有定論。液基細(xì)胞學(xué)(liquid-based thinprep cytology test,TCT)檢測、人乳頭瘤病毒(human papillomavirus,HPV)檢測、鱗狀細(xì)胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)檢測等方法均常用于宮頸癌治療后的隨訪中,但均具有局限性,導(dǎo)致一部分的宮頸癌復(fù)發(fā)患者被漏診,而HPV、TCT以及SCC-Ag三者聯(lián)合檢測應(yīng)用于宮頸癌治療后的隨訪中,能否提高宮頸癌復(fù)發(fā)患者的檢出率,目前尚未見相關(guān)文獻(xiàn)報道。此外,評估宮頸癌患者的預(yù)后并有效預(yù)測其復(fù)發(fā),對提高其生存率同樣具有重要意義。近年來研究表示,惡性腫瘤的發(fā)生發(fā)展、侵襲轉(zhuǎn)移及預(yù)后都與腫瘤微環(huán)境密切關(guān)聯(lián),二者既相互依存又相互制約,而膠原三股螺旋重復(fù)蛋白 1(Collagen triple helix repeat containing-1,CTHRC1)作為腫瘤微環(huán)境的重要成分之一,其在腫瘤中的作用也越來越被重視。近年來,異常表達(dá)的CTHRC1在多種實體腫瘤中被發(fā)現(xiàn),并且在肺癌、結(jié)直腸癌、胃癌、卵巢癌等惡性腫瘤的侵襲轉(zhuǎn)移過程中起重要作用,并是獨(dú)立生存預(yù)后影響因素。此外,研究表明,CTHRC1在宮頸疾病的發(fā)生發(fā)展過程中的表達(dá)呈現(xiàn)上升趨勢,但尚未有關(guān)于CTHRC1與宮頸癌復(fù)發(fā)及預(yù)后關(guān)系的深入研究。第一章HPV、TCT及SCC聯(lián)合檢測在宮頸癌治療后隨訪中的意義研究目的:探討HPV、TCT、SCC三者聯(lián)合檢測在宮頸癌治療后隨訪中的臨床價值。研究方法:通過對205例宮頸癌治療后患者數(shù)據(jù)進(jìn)行分析,將HPV、TCT、SCC三者聯(lián)合檢測與HPV、TCT、SCC三者單獨(dú)檢測、TCT聯(lián)合HPV檢測等宮頸癌治療后的隨訪方案進(jìn)行比較,尋找最佳的隨訪策略。研究結(jié)果:1.TCT、HPV及SCC聯(lián)合檢測時對宮頸癌治療后復(fù)發(fā)監(jiān)測的靈敏度及陰性預(yù)測值明顯高于其他四種檢測方案(TCT、HPV、SCC、TCT聯(lián)合HPV檢測)。2.TCT、HPV聯(lián)合SCC檢測對于遠(yuǎn)處轉(zhuǎn)移及局部復(fù)發(fā)檢測的靈敏度均高,且兩者間差異不具有統(tǒng)計學(xué)意義(P=0.643)。結(jié)論:1.TCT、HPV、SCC-Ag三者聯(lián)合檢測在監(jiān)測宮頸癌治療后的復(fù)發(fā)時,較TCT、HPV、SCC-Ag單獨(dú)檢測及TCT聯(lián)合HPV檢測等方案具有更高的靈敏度及陰性預(yù)測值,能夠更為敏感地提示宮頸癌復(fù)發(fā)。2.TCT、HPV、SCC-Ag三者聯(lián)合檢測對于宮頸癌治療后出現(xiàn)遠(yuǎn)處轉(zhuǎn)移及局部復(fù)發(fā)的患者的檢出均有較高的靈敏度。第二章CTHRC1在宮頸癌中的表達(dá)及其與預(yù)后的關(guān)系研究目的:檢測CTHRC1在宮頸癌組織中的表達(dá),探討其與宮頸癌復(fù)發(fā)及預(yù)后的關(guān)系。研究方法:檢測96例宮頸癌患者、28例CIN患者及30例正常宮頸患者的宮頸組織中CTHRC1的表達(dá)情況,分析CTHRC1的表達(dá)與宮頸癌復(fù)發(fā)及預(yù)后的關(guān)系。研究結(jié)果:1.CTHRC1在宮頸癌組織中的表達(dá)明顯高于正常宮頸組織及宮頸上皮內(nèi)瘤變組織,宮頸上皮內(nèi)瘤變組織中CTHRC1的表達(dá)亦高于正常宮頸組織。2.在復(fù)發(fā)的宮頸癌組織中,CTHRC1的表達(dá)明顯高于未復(fù)發(fā)者。3.在復(fù)發(fā)性宮頸癌中,復(fù)發(fā)后宮頸癌組織中CTHRC1的表達(dá)高于復(fù)發(fā)前。4.在不同年齡、組織學(xué)類型及腫瘤大小的宮頸癌患者中,CTHRC1的表達(dá)之間的差異不具有統(tǒng)計學(xué)意義(P0.05)。但是,CTHRC1的表達(dá)與宮頸癌患者的臨床分期、組織分化程度及淋巴結(jié)是否轉(zhuǎn)移相關(guān)(P0.05)。5.CTHRC1陰性表達(dá)組的無病生存時間及總生存時間均明顯長于陽性表達(dá)組,其差異具有顯著性。6.CTHRC1的表達(dá)及淋巴結(jié)轉(zhuǎn)移是宮頸癌患者無病生存預(yù)后的影響因子,而CTHRC1表達(dá)、淋巴結(jié)轉(zhuǎn)移、臨床分期、組織分化程度及腫瘤大小均為宮頸癌患者總生存預(yù)后的影響因子;此外,CTHRC1表達(dá)與淋巴結(jié)轉(zhuǎn)移、臨床分期及組織分化程度,均為宮頸癌患者總生存的獨(dú)立預(yù)后因素(P0.05)。結(jié)論:1.CTHRC1在宮頸癌組織中的表達(dá)比正常宮頸組織、CIN組織表達(dá)高;2.CTHRC1的表達(dá)可能與宮頸癌的復(fù)發(fā)相關(guān);3.CTHRC1的表達(dá)與宮頸癌患者的臨床分期、組織分化程度及淋巴結(jié)是否轉(zhuǎn)移等臨床病理因素相關(guān);4.CTHRC1的表達(dá)與宮頸癌的預(yù)后相關(guān),并是宮頸癌患者總生存的獨(dú)立預(yù)后因子。
[Abstract]:Background: cervical cancer is one of the most common gynecologic malignant tumor, a serious threat to the health and life of women. In recent years, with the rapid development of cervical cancer screening and diagnosis, improvement of surgical operation method, more and more patients to receive timely diagnosis and treatment of cervical cancer. But in the standardization of treatment, there are still some cervical cancer recurrence, which is the leading cause of death in patients with cervical cancer. Therefore, how to effectively forecast and early detection of cervical cancer recurrence and evaluate the prognosis of patients with cervical cancer, prolong the survival time, as many clinicians concern. Clinical follow-up regularly after the treatment of cervical cancer is helpful in the early diagnosis of cervix cancer recurrence, improve cervical cancer survival. However, the specific scheme of cervical cancer after treatment follow-up has not yet been finalized. The liquid based cytology (liquid-based ThinPrep cytology test, TCT) detection, people Papillomavirus (human papillomavirus, HPV) detection of squamous cell carcinoma antigen (squamous cell carcinoma antigen, SCC-Ag) detection methods are often used for the treatment of cervical cancer after follow-up, but all have limitations, resulting in the recurrence of cervical cancer patients was a part of the missed diagnosis, while HPV, TCT and SCC-Ag three combined used in the treatment of cervical cancer after follow-up, can improve the detection rate of patients with cervical cancer recurrence, there are no reports. In addition, evaluate the prognosis of patients with cervical cancer and predict the recurrence and to improve the survival rate also has an important significance in recent years. Research shows that the development of malignant tumor invasion. Metastasis and prognosis are closely related with the tumor microenvironment, the two interdependence and mutual restriction, and three collagen helix repeat protein 1 (Collagen triple helix repeat containing-1, CTHRC1) as a tumor One of the important components of the environment, its role in tumor has been paid more and more attention. In recent years, the abnormal expression of CTHRC1 was found in a variety of solid tumors, and lung cancer, colorectal cancer, gastric cancer, ovarian cancer and other malignant tumor invasion plays an important role in metastasis, and survival are independent prognostic factors. In addition, the research showed that the expression of CTHRC1 in the occurrence and development of cervical disease in the rise, but not deeply study on the relationship between the recurrence and prognosis of cervical cancer and CTHRC1 HPV. In the first chapter, the purpose and significance of TCT SCC detection in the follow-up of cervical cancer after treatment: To investigate the effect of HPV, TCT, clinical value the combined detection of SCC three in the follow-up after treatment of cervical cancer. Methods: the data of 205 cases of patients with cervical cancer after treatment of HPV, TCT, SCC combined detection of the three and HPV, TCT, SCC three test alone, TCT Compare the follow-up program combined with HPV detection of cervical cancer after treatment, to find the optimal follow-up strategy. Results: 1.TCT, HPV and SCC combined detection of sensitivity and negative predictive value of cervical cancer recurrence after treatment was significantly higher than that of the other four detection schemes (TCT, HPV, SCC, TCT and HPV combined detection).2.TCT HPV, SCC combined detection high sensitivity for detection of distant metastasis and local recurrence, and the difference was not statistically significant (P=0.643). Conclusion: 1.TCT, HPV, combined detection of SCC-Ag three in the monitoring of cervical cancer relapse after treatment, compared with TCT, HPV, SCC-Ag and TCT combined with single detection of HPV detection scheme has higher sensitivity and negative predictive value is more sensitive to prompt the recurrence of cervical cancer.2.TCT, HPV combined detection of SCC-Ag three for treatment of cervical cancer after detection of distant metastasis and local recurrence were higher in patients Objective to study the expression of sensitivity. The relationship between the second chapter CTHRC1 in cervical cancer and its prognosis: to detect the expression of CTHRC1 in cervical cancer tissues, and explore their relationship with prognosis and recurrence of cervical cancer. Methods: to detect 96 cases of cervical cancer, the expression of CTHRC1 in cervical tissue of 28 CIN patients and 30 cases of normal cervical patients in the analysis of the relationship between the expression of CTHRC1 and cervical cancer recurrence and prognosis. Results: the expression of 1.CTHRC1 in cervical cancer tissues was significantly higher than that in normal cervical tissues and cervical intraepithelial neoplasia, the expression of cervical intraepithelial neoplasia in CTHRC1 were higher than that of normal cervical tissue.2. in recurrence of cervical cancer tissue, the expression of CTHRC1 was significantly higher than that in non recurrent.3. in recurrent cervical cancer, the expression of CTHRC1 recurrence of cervical carcinoma tissues was higher than that before relapse.4. in different age, histological type and tumor size The cervical cancer patients, the difference between the expression of CTHRC1 was not statistically significant (P0.05). However, patients with stage CTHRC1 cervical cancer expression and clinical, histological differentiation and lymph node metastasis related (P0.05).5.CTHRC1 negative expression group of disease-free survival and overall survival were significantly longer than the positive group expression and lymph node, the difference was significant.6.CTHRC1 transfer is the influence factor of cervical cancer patients with disease-free survival prognosis, but the expression of CTHRC1, lymph node metastasis, clinical stage, histological differentiation and tumor size were overall survival in patients with cervical cancer prognostic factors; in addition, the expression of CTHRC1 and lymph node metastasis, clinical staging and histological differentiation, were independent prognostic factors for overall survival of patients with cervical cancer (P0.05). Conclusion: the expression of 1.CTHRC1 in cervical cancer tissue than in normal cervical tissue, high expression of CIN; 2 The expression of.CTHRC1 may be related with cervical cancer recurrence; staging of patients with cervical cancer clinical 3.CTHRC1 expression, histological differentiation and lymph node metastasis and clinical pathological factors; 4.CTHRC1 expression and prognosis of cervical cancer, and is an independent prognostic factor for overall survival of patients with cervical cancer.

【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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