本文選題：乳腺癌　切入點(diǎn)：雙原發(fā)癌　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析乳腺、肺雙原發(fā)癌(double primary cancers)患者的臨床病理學(xué)特征,探討影響乳腺、肺雙原發(fā)癌患者預(yù)后的相關(guān)因素。方法選取2000年1月至2015年12月經(jīng)天津腫瘤醫(yī)院手術(shù)和臨床病理診斷為乳腺癌合并肺癌128例的雙原發(fā)癌患者,其中乳腺病理是經(jīng)由乳腺病理確診,肺病理是經(jīng)由大病理確診。全組均為女性。對(duì)乳腺、肺雙原發(fā)癌患者的發(fā)病情況進(jìn)行分析。按發(fā)病時(shí)間間隔,將乳腺、肺雙原發(fā)癌患者分為同時(shí)性雙原發(fā)癌與異時(shí)性雙原發(fā)癌,將兩組的臨床病理學(xué)特征及預(yù)后進(jìn)行了分析比較。按照乳腺癌或肺癌的發(fā)病時(shí)間順序先后,分為乳腺癌首發(fā)雙原發(fā)癌和肺癌首發(fā)雙原發(fā)癌,進(jìn)行臨床病理學(xué)特征進(jìn)行分析比較,并探討影響雙原發(fā)癌患者預(yù)后的相關(guān)因素。采用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行分析。各組數(shù)據(jù)間的比較采用χ2檢驗(yàn),應(yīng)用Kaplan-Meier法進(jìn)行生存分析,單因素分析采用Log rank檢驗(yàn),多因素分析采用Cox比例風(fēng)險(xiǎn)回歸模型。P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果128例乳腺、肺雙原發(fā)癌患者中,占同期乳腺癌的0.2%(128/44705)、同期女性肺癌的1%(128/12637)。同時(shí)性雙原發(fā)癌有5人,異時(shí)性雙原發(fā)癌有123人。乳腺癌作為第一原發(fā)癌合并肺癌有113例、肺癌作為第一原發(fā)癌合并乳腺癌有15例。有39%的患者訴有腫瘤家族史。63.2%的患者已閉經(jīng)。在首發(fā)乳腺癌與首發(fā)肺癌的自查或查體的肺癌發(fā)現(xiàn)方式上具有統(tǒng)計(jì)學(xué)意義(0.000.05);在氣管鏡檢查、針吸、手術(shù)這三種肺癌確診方式上有統(tǒng)計(jì)學(xué)意義(0.030.05);在肺癌臨床分期上有統(tǒng)計(jì)學(xué)意義(0.020.05);在肺癌區(qū)域淋巴結(jié)分期上具有統(tǒng)計(jì)學(xué)意義(0.000.05)。乳腺癌首發(fā)的雙原發(fā)癌與肺癌首發(fā)的雙原發(fā)癌兩組之間的差異具有統(tǒng)計(jì)學(xué)意義,肺癌首發(fā)的雙原發(fā)癌患者較乳腺癌首發(fā)的雙原發(fā)癌患者預(yù)后差(P=0.002)。同時(shí)性雙原發(fā)癌與異時(shí)性雙原發(fā)癌兩組之間的差異具有統(tǒng)計(jì)學(xué)意義,同時(shí)性雙原發(fā)癌患者較異時(shí)性雙原發(fā)癌患者預(yù)后差(P=0.00)。在肺癌病理類型之間差異有統(tǒng)計(jì)學(xué)意義。肺癌病理類型是影響患者預(yù)后的因素(P0.05)。首發(fā)癌的確診年齡、乳腺癌組織學(xué)分級(jí)、肺癌病理類型是乳腺、肺雙原發(fā)癌患者的獨(dú)立預(yù)后因素。首發(fā)癌確診年齡越晚、乳腺癌組織學(xué)分級(jí)高、肺癌病理類型不同為乳腺、肺雙原發(fā)癌患者預(yù)后不良的獨(dú)立危險(xiǎn)因素。結(jié)論1.共選取了128例乳腺、肺雙原發(fā)癌女性患者資料,中位年齡59歲,占同期乳腺癌的0.2%(128/44705)、同期女性肺癌的1%(128/12637),其中乳腺癌作為第一原發(fā)癌合并肺癌有113例、肺癌作為第一原發(fā)癌合并乳腺癌有15例。2.由于肺癌的臨床癥狀往往較為隱匿,常不被發(fā)覺,通常有癥狀再發(fā)現(xiàn)通常致分期較晚,在此128位患者中有大多數(shù)是乳腺癌首發(fā)的,在綜合治療之后會(huì)定期復(fù)查,復(fù)查手段里包括了胸部影像學(xué)檢查,對(duì)發(fā)現(xiàn)肺部病灶有很大的作用。因此我們針對(duì)肺癌的發(fā)現(xiàn)、確診方式、臨床分期、腫瘤最大直徑、區(qū)域淋巴結(jié)分期來分析。在首發(fā)乳腺癌與首發(fā)肺癌的自查或查體的肺癌發(fā)現(xiàn)方式上具有統(tǒng)計(jì)學(xué)意義;在氣管鏡檢查、針吸、手術(shù)這三種肺癌確診方式上有統(tǒng)計(jì)學(xué)意義;在肺癌臨床分期上有統(tǒng)計(jì)學(xué)意義;在肺癌區(qū)域淋巴結(jié)分期上具有統(tǒng)計(jì)學(xué)意義。因?yàn)橛卸ㄆ诘挠跋駥W(xué)檢查,所以能更早的發(fā)現(xiàn)肺部病灶的發(fā)生。3.乳腺癌首發(fā)的雙原發(fā)癌與肺癌首發(fā)的雙原發(fā)癌兩組之間的差異具有統(tǒng)計(jì)學(xué)意義,肺癌首發(fā)的雙原發(fā)癌患者較乳腺癌首發(fā)的雙原發(fā)癌患者預(yù)后差。同時(shí)性雙原發(fā)癌與異時(shí)性雙原發(fā)癌兩組之間的差異具有統(tǒng)計(jì)學(xué)意義,同時(shí)性雙原發(fā)癌患者較異時(shí)性雙原發(fā)癌患者預(yù)后差。肺癌病理類型是影響患者預(yù)后的因素。4.首發(fā)癌的確診年齡、乳腺癌組織學(xué)分級(jí)、肺癌病理類型是乳腺、肺雙原發(fā)癌患者的獨(dú)立預(yù)后因素。
[Abstract]:Objective to analyze the breast, lung, double primary cancer (double primary cancers) clinical and pathological characteristics of patients, to explore the influence factors related to breast cancer prognosis of patients with double primary lung. Methods from January 2000 to 2015 12 menstrual Tianjin Cancer Hospital surgery and clinical pathological diagnosis of breast cancer with lung cancer in 128 cases of double primary cancer patients. One is through the pathological diagnosis of breast pathology of breast, lung pathology is through pathology. All the patients were female. The breast, analyzed the incidence of patients with double primary pulmonary carcinoma. The breast according to onset time interval, double primary pulmonary carcinoma patients were divided into synchronous double primary cancer and metachronous double primary cancer, the clinical pathological characteristics and prognosis of the two groups were analyzed and compared. According to the time sequence of onset of breast cancer or lung cancer were divided into breast carcinoma presenting double primary cancer and lung cancer the first primary cancer, clinical pathology Characteristics were analyzed and compared, and the factors related to the prognosis of patients with double primary carcinoma. Were analyzed by SPSS21.0 statistical software. The data were compared using chi square test 2, by using the method of Kaplan-Meier survival analysis, univariate analysis using the Log rank test, multivariate analysis using Cox proportional hazards regression model for the difference is.P0.05 statistical significance. Results 128 cases of breast, double primary pulmonary carcinoma, breast cancer accounted for 0.2% (128/44705), over the same period of female lung cancer 1% (128/12637). At the same time of double primary carcinoma 5, metachronous multiple primary carcinoma 123. Breast cancer as the first primary carcinoma there were 113 cases of lung cancer, lung cancer as the first primary carcinoma in patients with breast cancer in 15 cases. 39% patients complained of.63.2% family history of cancer patients have amenorrhea. With the self in the first breast cancer and lung cancer or first examination found on lung cancer Statistically significant (0.000.05); in bronchoscopy, needle aspiration, operation was significant of the three lung cancer diagnosis method (0.030.05); there was statistical significance in the clinical staging of lung cancer (0.020.05) in lung cancer; lymph node staging area with statistical significance (0.000.05). The difference was statistically significant between the two groups the first two breast cancer primary cancer and lung cancer first double primary carcinoma of lung cancer, the first double primary cancer patients with breast cancer the first double primary cancer patients with poor prognosis (P=0.002). At the same time has statistical significance of double primary cancer and metachronous multiple primary carcinoma of the differences between the two groups. At the same time of double primary cancer patients with metachronous primary cancer patients with poor prognosis (P=0.00). The pathological type of lung cancer was statistically significant. The pathological type of lung cancer is a prognostic factor (P0.05). The age of diagnosis of the first cancer, histological grade of breast cancer, The pathological type of lung cancer is an independent prognostic factor in patients with breast and lung cancer. The first double primary cancer diagnosis of the late age, histological grade of breast cancer, the pathological type of lung cancer in different breast, independent risk factors for pulmonary double primary cancer in patients with poor prognosis. Conclusion: 1. a total of 128 cases of mammary gland, two primary lung the information of cancer of female patients, median age 59 years, accounted for 0.2% of breast cancer (128/44705), over the same period of female lung cancer 1% (128/12637), including breast cancer as the first primary carcinoma in 113 cases with lung cancer, lung cancer as the first primary cancer associated with breast cancer in 15 cases of.2. due to the clinical symptoms of lung cancer often more hidden, often are not found, usually have symptoms usually caused by late stage and found that, in 128 patients with breast cancer is the most first, in the comprehensive treatment after regular review, review methods include chest imaging, found in lung disease Kitchen has a great effect. So we found for lung cancer, diagnosis, clinical staging, tumor diameter, lymph node staging analysis. Statistical significance of self-examination in the starting of breast cancer and lung cancer or first examination found the way in lung cancer; bronchoscope examination, needle aspiration, operation was significant these three kinds of methods in the diagnosis of primary lung cancer; clinical staging of lung cancer was statistically significant; in the regional lymph node staging of lung cancer was statistically significant. Because there are regular imaging, so have found statistically significant differences between the two groups of pulmonary lesions occurred in.3. breast cancer first double primary cancer and lung cancer the first double primary carcinoma of lung cancer, the first double primary cancer patients with breast cancer the first primary cancer patients with poor prognosis. At the same time of double primary cancer and metachronous multiple primary carcinoma between the two groups has difference Statistical significance of double primary cancer patients with poor prognosis and double primary cancer patients with different pathological types of lung cancer is diagnosed. The age factors influencing the prognosis of patients with.4. onset cancer, histological grade of breast cancer tissue, the pathological type of lung cancer is breast, independent pre double primary cancer in patients with pulmonary factors.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.9;R734.2

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