本文選題：鏡下Ⅰb1期宮頸鱗癌 + 病理特征　； 參考：《天津醫(yī)科大學(xué)》2017年博士論文

【摘要】：目的:(1)明確并比較鏡下與臨床可見(jiàn)Ⅰb1期宮頸鱗癌臨床病理因素差異及對(duì)預(yù)后的影響。(2)比較不同神經(jīng)侵犯狀態(tài)Ⅰb1期宮頸鱗癌臨床病理特征。(3)闡述FABP7與NCAM在不同神經(jīng)侵犯Ⅰb1期宮頸鱗癌的臨床意義及相關(guān)關(guān)系。材料與方法:(1)回顧性分析我院自2011年4月1日至2015年8月31日的Ⅰb1期宮頸鱗狀細(xì)胞癌行根治性全子宮切除術(shù)患者的臨床病理資料。分為鏡下組及臨床可見(jiàn)組,比較兩組間臨床病理特征差異及對(duì)預(yù)后的影響。(2)采用回顧性方法分析PNI(+)及PNI(-)Ⅰb1期宮頸鱗癌患者的臨床病理特征。(3)免疫組化法檢測(cè)PNI(+)及PNI(-)Ⅰb1期宮頸鱗癌患者中FABP7及NCAM表達(dá),分析其與臨床病理因素的關(guān)系。結(jié)果:(1)共納入鏡下Ⅰb1期宮頸鱗癌患者49例,中位隨訪時(shí)間33±15.0月。鏡下組患者Ⅰ型轉(zhuǎn)化區(qū)占71%;Ⅱ型轉(zhuǎn)化區(qū)患者占6%;Ⅲ型轉(zhuǎn)化區(qū)患者占23%;滿意陰道鏡檢查占77.5%;不滿意陰道鏡檢查占22.5%;宮頸活檢病理提示HSIL占55%;陰道鏡下宮頸活檢病理提示可疑微侵癌患者占45%。鏡下組錐切術(shù)后殘留HSIL及以上者占78%;LSIL及以下占22%;錐切術(shù)后病理浸潤(rùn)類型中迷芽狀浸潤(rùn)27例,占55%;“舌狀”浸潤(rùn)22例,占45%。僅有1例宮旁淋巴結(jié)轉(zhuǎn)移;1例陰道切緣未凈;1例復(fù)發(fā)并死亡。(2)共納入Ⅰb1期宮頸鱗癌患者共198例,鏡下組患者49例,臨床可見(jiàn)組患者149例,兩組間中位年齡(t=1.563,p=0.120)及隨訪時(shí)間(p=0.149)比較無(wú)差異。鏡下組及臨床可見(jiàn)組患者術(shù)前血清Scc-Ag異常率、組織學(xué)分化、LVSI、間質(zhì)浸潤(rùn)深度、盆腔淋巴結(jié)轉(zhuǎn)移、術(shù)后輔助治療等六方面比較差異顯著;術(shù)后陰道切緣、PI、復(fù)發(fā)及生存比較無(wú)顯著性差異。單因素分析未提示LVSI、侵間質(zhì)深度、宮旁轉(zhuǎn)移及切緣陽(yáng)性影響預(yù)后;單因素分析LVSI、腫瘤大小、浸潤(rùn)深度是盆腔淋巴結(jié)轉(zhuǎn)移的影響因素,多因素分析顯示僅有間質(zhì)浸潤(rùn)深度是盆腔淋巴結(jié)轉(zhuǎn)移的獨(dú)立影響因素。(3)光鏡篩查腫瘤直徑2cm的Ⅰb1期宮頸鱗癌患者56例,發(fā)現(xiàn)PNI(+)患者26例,PNI(-)患者30例,兩組間中位年齡(t=1.063,p=0.221)及隨訪時(shí)間(p=0.219)比較無(wú)差異。PNI(+)組與PNI(-)組患者術(shù)前血清Scc-Ag異常率、間質(zhì)浸潤(rùn)深度、LVSI、組織學(xué)分化、PI、陰道切緣受累,復(fù)發(fā)及生存比較,無(wú)顯著性差異。兩組患者間盆腔淋巴結(jié)轉(zhuǎn)移率比較差異顯著。FABP7免疫組化染色,腫瘤細(xì)胞陽(yáng)性率為20%(11/56),其中PNI(+)組腫瘤細(xì)胞陽(yáng)性率為38%(10/26),PNI(-)組陽(yáng)性率為3%(1/30),腫瘤細(xì)胞染色兩組比較差異有統(tǒng)計(jì)學(xué)意義(?2=8.777,p=0.003)。PNI(+)組雪旺細(xì)胞著色4例,PNI(-)組雪旺細(xì)胞著色1例,兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組中均未出現(xiàn)腫瘤組織及瘤旁組織淋巴細(xì)胞著色。NCAM免疫組化染色,腫瘤細(xì)胞陽(yáng)性率約為7%(4/56),PNI(+)組腫瘤細(xì)胞無(wú)陽(yáng)性患者,PNI(-)組4例,陽(yáng)性率約為13%(4/30),兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組中均未出現(xiàn)雪旺細(xì)胞著色,兩組中各有1例出現(xiàn)腫瘤組織中淋巴細(xì)胞著色。PNI(+)患者中腫瘤周圍組織中淋巴細(xì)胞僅1例著色,而PNI(-)患者中6例陽(yáng)性著色,兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:(1)鏡下Ⅰb1期宮頸鱗癌患者總體預(yù)后好,LVSI發(fā)生率較高,盆腔淋巴結(jié)轉(zhuǎn)移、陰道切緣陽(yáng)性、宮旁陽(yáng)性、術(shù)后輔助治療率低;鏡下Ⅰb1期宮頸鱗癌高危因素低于臨床可見(jiàn)Ⅰb1期宮頸鱗癌。(2)Ⅰb1期宮頸鱗癌中LVSI、間質(zhì)浸潤(rùn)深度、腫瘤大小與盆腔淋巴結(jié)轉(zhuǎn)移有關(guān),間質(zhì)浸潤(rùn)深度是盆腔淋巴結(jié)轉(zhuǎn)移獨(dú)立影響因素。(3)Ⅰb1期宮頸鱗癌PNI的發(fā)生與盆腔淋巴結(jié)轉(zhuǎn)移有關(guān)。(4)腫瘤細(xì)胞中FABP7表達(dá)增高可能與PNI發(fā)生有關(guān),并促進(jìn)宮頸癌的神經(jīng)侵襲。宮頸鱗癌腫瘤細(xì)胞很少表達(dá)NCAM。
[Abstract]:Objective: (1) clear and compare endoscopic and clinical stage B1 cervical squamous cell carcinoma of the visible pathological differences and influencing factors on the prognosis. (2) to compare the different state of nerve invasion stage I B1 cervical squamous cell carcinoma of the clinical and pathological characteristics. (3) of FABP7 and NCAM in the clinical significance and relationship of different nerve invasion stage I B1 cervical squamous cell carcinoma. Materials and methods: (1) a retrospective analysis of our hospital from April 1, 2011 to August 31, 2015 of B1 cervical squamous cell cancer underwent clinical and pathological data of hysterectomy patients. Divided into endoscopic group and visible clinical group, compare the clinical and pathological features of the difference between the two groups and the influence on prognosis. (2) using the method of analysis of a review of the PNI (+) and PNI (-) B1 phase I clinical pathological characteristics of cervical squamous cell carcinoma (3). Immunohistochemical detection of PNI (+) and PNI (-) FABP7 I B1 and NCAM in cervical squamous cell carcinoma and its expression, analysis of clinical pathological factors 鐨勫叧緋，

本文編號(hào)：1748588