本文選題：上皮性卵巢癌 + 中性粒細(xì)胞與淋巴細(xì)胞比值　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討上皮性卵巢癌的預(yù)后影響因素,為進(jìn)一步的合理治療提供依據(jù)。方法:收集2009年1月1日至2011年7月1日于河北醫(yī)科大學(xué)第四醫(yī)院婦科初治的267例上皮性卵巢癌患者的臨床資料,采用回顧性分析的方法,對患病年齡、初潮年齡、絕經(jīng)情況、孕產(chǎn)次、絕育術(shù)史、惡性腫瘤家族史、合并子宮內(nèi)膜異位性疾病、初治時及化療3程后CA125水平、中性粒細(xì)胞與淋巴細(xì)胞比值(neutrophil-to-lymphocyte ratio,NLR)、淋巴細(xì)胞與單核細(xì)胞比值(lymphocyte-to-monocyte ratio,LMR)、腹水情況、卵巢腫瘤生長情況、腹膜后淋巴結(jié)切除情況、殘余灶大小、病理類型、組織分化程度、國際婦產(chǎn)科聯(lián)盟(International Federation of Gynecology and Obstetrics,FIGO)分期及術(shù)后化療情況與上皮性卵巢癌患者預(yù)后的關(guān)系進(jìn)行研究。通過建立受試者工作特征曲線(receiver operating characteristic curve,ROC曲線),確定術(shù)前外周血NLR及LMR判斷預(yù)后的最佳截點(diǎn)。采用Kaplan-Meier法進(jìn)行生存分析,Cox逐步回歸法分析影響預(yù)后的獨(dú)立因素。結(jié)果:1截至2016年7月1日,267例上皮性卵巢癌患者中死亡125例,3年、5年生存率分別為70.2%、50.6%;復(fù)發(fā)168例,3年、5年無進(jìn)展生存率分別為45.6%、34.3%。2單因素分析顯示患病年齡、初潮年齡、是否絕經(jīng)、初治時CA125水平、化療3程后CA125水平、NLR、LMR、有無腹水、腹水或腹腔沖洗液中有無癌細(xì)胞、卵巢腫瘤單雙側(cè)生長、是否行淋巴結(jié)切除、淋巴結(jié)轉(zhuǎn)移、殘余灶大小、病理類型、分化程度、FIGO分期及術(shù)后化療療程與患者的總生存期有關(guān)(P0.05)�；疾∧挲g、初潮年齡、惡性腫瘤家族史、初治時CA125水平、化療3程后CA125水平、NLR、LMR、有無腹水、腹水或腹腔沖洗液中有無癌細(xì)胞、卵巢腫瘤單雙側(cè)生長、卵巢腫瘤直徑、是否行淋巴結(jié)切除、淋巴結(jié)轉(zhuǎn)移、殘余灶大小、病理類型、分化程度、FIGO分期及術(shù)后化療療程與患者的無進(jìn)展生存期有關(guān)(P0.05)。3多因素分析顯示化療3程后CA125水平、卵巢腫瘤單雙側(cè)生長、病理類型、分化程度及FIGO分期是影響上皮性卵巢癌患者總生存期的獨(dú)立預(yù)后因素(P0.05)。初治時CA125水平、化療3程后CA125水平、NLR、卵巢腫瘤單雙側(cè)生長、病理類型、分化程度及FIGO分期是影響上皮性卵巢癌患者無進(jìn)展生存期的獨(dú)立預(yù)后因素(P0.05)。結(jié)論:化療3程后CA125水平、卵巢腫瘤單雙側(cè)生長、病理類型、分化程度及FIGO分期是影響上皮性卵巢癌患者總生存期及無進(jìn)展生存期的獨(dú)立預(yù)后因素。初治時CA125水平和NLR為影響患者無進(jìn)展生存期的獨(dú)立預(yù)后因素。
[Abstract]:Objective: to explore the prognostic factors of epithelial ovarian cancer and to provide evidence for further rational treatment. Methods: from January 1, 2009 to July 1, 2011, 267 patients with epithelial ovarian cancer were collected from the fourth Hospital of Hebei Medical University. The age of disease, age of menarche and menopause were analyzed retrospectively. Pregnancy and childbirth, history of sterilization, family history of malignant tumor, complicated with endometriosis, CA125 level at first treatment and after chemotherapy, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, ascites, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte LMRs, ascites, neutrophil-to-lymphocyte ratio, lymphocyte-to-monocyte / monocyte ratio, ascites, neutrophil-to-lymphocyte ratio, Ovarian tumor growth, retroperitoneal lymphadenectomy, residual lesion size, pathological type, tissue differentiation, The relationship between the stage of International Federation of Gynecology and Obstetrics Figo and the prognosis of patients with epithelial ovarian cancer was studied. By setting up the receiver operating characteristic curve, the best point for judging the prognosis of peripheral blood NLR and LMR before operation was determined. Survival analysis was performed by Kaplan-Meier method and Cox stepwise regression was used to analyze the independent prognostic factors. Results as of July 1, 2016, 125 of 267 patients with epithelial ovarian cancer died, the 3-year and 5-year survival rates were 70.22 and 50.6, respectively, and the survival rates of 168 relapses, 3 years, and 5 years without progression were 45.634. 34.2%. Single factor analysis showed that the age of disease, the age of menarche, whether menopause was menopausal. At the beginning of treatment, the level of CA125, the level of CA125 after three stages of chemotherapy, the presence of ascites, the presence of cancer cells in ascites or peritoneal lavage, the unilateral and bilateral growth of ovarian tumors, whether lymph node resection, lymph node metastasis, the size of residual foci, and pathological types were observed. The degree of differentiation and Figo stage and the course of chemotherapy after operation were related to the total survival time of the patients (P 0.05). Age of disease, age of menarche, family history of malignant tumor, CA125 level at first treatment, CA125 level after 3 stages of chemotherapy, ascites, cancer cells in ascites or peritoneal lavage, growth of ovarian tumor unilateral and bilateral, diameter of ovarian tumor. Whether or not lymph node resection, lymph node metastasis, residual lesion size, pathological type, differentiation degree, Figo stage and postoperative chemotherapy course were related to the progression free survival of the patients were correlated with the multivariate analysis of P0.053.The multivariate analysis showed that the level of CA125 was found after 3 stages of chemotherapy. The growth, pathological type, differentiation degree and FIGO stage of ovarian tumors were independent prognostic factors for the overall survival period of patients with epithelial ovarian cancer (EOC). The level of CA125, the level of CA125 after three stages of chemotherapy, the growth, pathological type, differentiation and FIGO stage of ovarian tumors were the independent prognostic factors of progressive survival in patients with epithelial ovarian cancer (EOC). Conclusion: the levels of CA125, unilateral and bilateral growth, pathological type, differentiation degree and FIGO stage are independent prognostic factors in patients with epithelial ovarian cancer after three stages of chemotherapy. CA125 level and NLR were independent prognostic factors for progressive survival.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.31

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