本文選題：鼻咽腫瘤　切入點(diǎn)：腫瘤分期　出處：《福建醫(yī)科大學(xué)》2014年博士論文　論文類(lèi)型：學(xué)位論文

【摘要】：第一部分基于調(diào)強(qiáng)放療的鼻咽癌AJCC分期研究背景與目的評(píng)估第七版AJCC分期標(biāo)準(zhǔn)對(duì)于接受根治性調(diào)強(qiáng)放療的鼻咽癌患者的適用性。材料與方法收集1241例基于MRI掃描的首診鼻咽癌患者臨床數(shù)據(jù),由兩位頭頸部專(zhuān)業(yè)影像學(xué)醫(yī)師獨(dú)立復(fù)閱全部MRI影像資料。對(duì)影響無(wú)局部復(fù)發(fā)生存(LRFS)、無(wú)遠(yuǎn)處轉(zhuǎn)移生存(DMFS)、疾病相關(guān)生存(DSS)的預(yù)后因素進(jìn)行分析。結(jié)果T1與T2、T2與T3間的LRFS差別無(wú)統(tǒng)計(jì)學(xué)意義(P=0.055、P=0.605)。T2與T3、T3與T4之間的DSS差別有統(tǒng)計(jì)學(xué)意義,但T1與T2之間的DSS差別無(wú)意義(P=0.070)。對(duì)于T1~T3期病人,雖然顱底骨質(zhì)侵犯對(duì)局部復(fù)發(fā)無(wú)影響,卻是遠(yuǎn)處轉(zhuǎn)移和疾病相關(guān)死亡的獨(dú)立預(yù)后因素。T3期伴有MRI診斷的顱神經(jīng)侵犯患者生存好于T4期,而T3期伴或不伴MRI診斷的顱神經(jīng)侵犯兩組病人之間的生存差別均無(wú)統(tǒng)計(jì)學(xué)意義。III期伴或不伴MRI診斷的顱神經(jīng)侵犯兩組病人之間的生存差別也無(wú)統(tǒng)計(jì)學(xué)意義,而且均好于IV期。N0與N1、N1與N2之間的DMFS有差別,但N2與N3a、N3a與N3b之間的DMFS差別無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論鼻咽癌采用IMRT治療后,N分期的預(yù)后作用變化不明顯,但T1與T2之間的LRFS及DSS差距縮小,提示將現(xiàn)行T分期標(biāo)準(zhǔn)中T2與T1合并較為合理。T3/III期病人伴或不伴MRI診斷的顱神經(jīng)侵犯生存相似,均好于T4/IV期,說(shuō)明T3期伴有MRI診斷的顱神經(jīng)侵犯患者不應(yīng)歸為T(mén)4期。第二部分:EB病毒mi RNA-BART7在臨床中的應(yīng)用價(jià)值背景與目的通過(guò)檢測(cè)鼻咽癌患者與非鼻咽癌個(gè)體血漿中EB病毒編碼的mi RNA-BART7的表達(dá)情況,評(píng)估m(xù)i RNA-BART7作為鼻咽癌腫瘤標(biāo)志物在臨床中的應(yīng)用價(jià)值。材料與方法收集91例鼻咽癌、17例非鼻咽癌腫瘤患者治療前血標(biāo)本,以28例鼻咽癌高發(fā)區(qū)健康人體檢血作為對(duì)照。另收集其中41例首診鼻咽癌患者根治性放療結(jié)束時(shí)的血標(biāo)本。熒光定量PCR法檢測(cè)血漿mi RNA-BART7的表達(dá)量,與患者的臨床分期、腫瘤體積、治療情況等臨床信息進(jìn)行相關(guān)性分析。同時(shí)檢測(cè)患者血漿EBV DNA、血清EBV VCA-Ig A、EA-Ig A、Rta-Ig G的濃度,對(duì)比評(píng)估m(xù)i RNA-BART7對(duì)鼻咽癌診斷、療效檢測(cè)、預(yù)測(cè)預(yù)后的價(jià)值。結(jié)果mi RNA-BART7在鼻咽癌患者中高表達(dá),而在非鼻咽癌腫瘤患者及健康對(duì)照者血漿中低表達(dá)。ROC曲線示mi RNA-BART7對(duì)鼻咽癌診斷的準(zhǔn)確率為0.912(95%置信區(qū)間:0.863-0.962)。鼻咽癌患者治療前血漿mi RNA-BART7表達(dá)量與T分期、N分期及臨床分期、腫瘤體積相關(guān),分期越晚體積越大,表達(dá)量越大。mi RNA-BART7相比于EBV DNA在鼻咽癌中有更高的陽(yáng)性率(95.5%vs.51.3%),相比于EBV相關(guān)抗體的優(yōu)點(diǎn)在與前者在治療后表達(dá)顯著下降,而抗體濃度在治療后變化無(wú)規(guī)律。結(jié)論血漿mi RNA-BART7檢測(cè)診斷鼻咽癌的準(zhǔn)確性高,且與臨床分期、腫瘤體積密切相關(guān),并在治療后下降至接近正常的水平,是較有前景的鼻咽癌腫瘤標(biāo)志物。
[Abstract]:Part I background and objective to evaluate the applicability of 7th AJCC staging criteria for nasopharyngeal carcinoma patients undergoing radical intensity modulated radiotherapy (IMRT). Materials and methods A total of 1241 cases of nasopharyngeal carcinoma based on MRI scanning. Clinical data of patients with nasopharyngeal carcinoma, All MRI images were reviewed independently by two head and neck professional imaging physicians. The prognostic factors affecting survival without local recurrence, survival without distant metastasis and disease associated survival were analyzed. Results T1 and T _ 2T _ 2 were compared with T _ 3. There was no significant difference in DSS between T3 and T4, and there was no significant difference in DSS between T3T3 and T4. However, there was no significant difference in DSS between T1 and T2. For T _ 1 / T _ 3 patients, although the skull base bone invasion had no effect on local recurrence, there was no significant difference between T _ 1 and T _ 2. However, the patients with cranial nerve invasion diagnosed by MRI in stage T3 were better than those in stage T4, which were independent prognostic factors of distant metastasis and disease-related death. However, there was no significant difference in survival between the patients with or without MRI diagnosis in T3 stage. There was no significant difference in survival between the two groups with or without MRI diagnosis, and there was no significant difference in survival between the two groups, and there was no significant difference in survival between the patients with or without cranial nerve invasion diagnosed by MRI. All of them were better than those of stage IV. N0 and N1N 1 and N 2, but there was no significant difference in DMFS between N 2 and N 3a N 3a and N 3b. Conclusion the prognostic effect of N staging in patients with nasopharyngeal carcinoma treated with IMRT is not significant. However, the difference of LRFS and DSS between T 1 and T 2 was narrowed, which suggested that T 2 and T 1 were more reasonable in T 3 / III stage patients than in T 4 / IV stage patients with or without MRI, and the survival of the patients with cranial nerve invasion was similar, which was better than that of T 4 / IV stage. The results showed that the patients with cranial nerve invasion diagnosed by MRI in T3 stage should not be classified as stage T4. Part two: Epstein-Barr virus mi RNA-BART7 in clinical application background and objective to detect Epstein-Barr virus coding in plasma of patients with nasopharyngeal carcinoma and non-nasopharyngeal carcinoma patients. The expression of the mi RNA-BART7 of the code, To evaluate the clinical value of mi RNA-BART7 as a tumor marker for nasopharyngeal carcinoma (NPC). Materials and methods Blood samples were collected from 91 patients with nasopharyngeal carcinoma (NPC) and 17 patients with nonnasopharyngeal carcinoma (NNPC) before treatment. The blood samples of 41 patients with nasopharyngeal carcinoma at the end of radical radiotherapy were collected. The expression of plasma mi RNA-BART7 was detected by fluorescence quantitative PCR, and compared with the clinical stage of the patients. The clinical information of tumor volume and treatment were analyzed, and the plasma EBV DNA and serum EBV VCA-Ig Amita-Ig Rta-Ig G were detected, and the diagnosis and curative effect of mi RNA-BART7 on nasopharyngeal carcinoma were compared and evaluated. Results the expression of mi RNA-BART7 was highly expressed in patients with nasopharyngeal carcinoma. The accuracy of mi RNA-BART7 in the diagnosis of nasopharyngeal carcinoma was 0.912 ~ 95% confidence interval: 0.863-0.9620.The expression of RNA-BART7 in plasma of patients with nasopharyngeal carcinoma before treatment and T stage N stage and clinical stage were higher than those in normal controls. Compared with EBV DNA, the tumor volume was significantly higher than that of EBV DNA. Compared with the former, the positive rate of the tumor volume was significantly higher than that of EBV DNA. Compared with the former, the expression of EBV related antibodies decreased significantly. Conclusion the accuracy of plasma mi RNA-BART7 in the diagnosis of nasopharyngeal carcinoma is high, which is closely related to clinical stage and tumor volume, and decreases to the normal level after treatment. It is a promising tumor marker for nasopharyngeal carcinoma.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R739.63

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 Margot Z銉ller;;Pancreatic cancer diagnosis by free and exosomal miRNA[J];World Journal of Gastrointestinal Pathophysiology;2013年04期

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本文編號(hào)：1607221