發(fā)布時間：2018-06-07 17:28

  本文選題：喉腫瘤 + 放射療法�。� 參考：《山西醫(yī)科大學》2011年博士論文

【摘要】：目的:通過采用系統(tǒng)評價的方法,評估單純手術(shù)及手術(shù)與放療相結(jié)合治療喉癌的療效,為臨床喉癌的合理治療提供循證學依據(jù)。 方法:按照Cochrane系統(tǒng)評估的方法,系統(tǒng)檢索Cochrane圖書館、Medline、Embase、中國生物醫(yī)學數(shù)據(jù)庫(CBM)、相關(guān)期刊論文(CNKI)等國內(nèi)外權(quán)威數(shù)據(jù)庫中有關(guān)喉癌外科治療的所有文獻,將喉癌治療方式中開放性喉切除術(shù)、單純CO2激光手術(shù)、單純放療、術(shù)前放療加手術(shù)及手術(shù)加術(shù)后放療治療后患者生存率、生存質(zhì)量和嗓音質(zhì)量分別進行兩兩比較。使用Revman5.0.17對符合納入標準的文獻進行Meta分析,對定量資料中二分類變量采用RR和95%CI表示效應(yīng)量,對定性資料采用描述性分析。檢索時間截至為2011年3月31日。 結(jié)果:按照檢索策略進行文獻檢索,符合納入標準的文獻共63篇,其中隨機對照試驗7篇,前瞻性非隨機對照試驗1篇,其余均為回顧性研究。研究分為9個比較組。結(jié)果顯示: (1)對不同術(shù)式的開放性喉部分切除術(shù)療效進行比較的文獻共8篇,未描述各組患者的分期分型。A:3年生存率:3年總生存率為85.88%(949/1105)。喉裂開聲帶切除術(shù)優(yōu)于聲門上水平喉部分切除術(shù)、水平垂直喉部分切除術(shù)及近全喉切除術(shù)RR分別為0.28、0.14、0.23,95%CI分別為(0.10,0.78)、(0.04,0.50)、(0.08,0.66)。B:5年生存率:5年總生存率為73.19%(685/899)。喉裂開聲帶切除術(shù)優(yōu)于側(cè)位垂直喉部分切除術(shù)、聲門上水平喉部分切除術(shù)、水平垂直喉部分切除術(shù)及近全喉切除術(shù),RR為0.37、0.27、0.25、0.23,95%CI為(0.18,0.75)、(0.14,0.51)、(0.12,0.50)、(0.08,0.72)。垂直半喉切除術(shù)、水平半喉切除及喉次全切除均優(yōu)于喉全切除術(shù),RR為0.26、0.22、0.45,95%CI為(0.13,0.51)、(0.07,0.68)、(0.23,0.87)。C:10年生存率:10年總生存率為54.29%(177/326)。喉裂開聲帶切除術(shù)優(yōu)于前位喉部分切除術(shù)、聲門上水平喉部分切除術(shù)、水平垂直喉部分切除術(shù)、擴大喉部分切除術(shù)及近喉全切除術(shù),RR為0.34、0.34、0.38、0.28、0.34,95%CI為(0.14,0.87)、(0.15,0.81)、(0.16,0.94)、(0.12,0.65)、(0.17,0.66)。垂直半喉切除術(shù)和水平半喉切除術(shù)優(yōu)于喉全切除術(shù),RR為0.45、0.49,95%CI為(0.28,0.73)、(0.26,0.93)。側(cè)位垂直喉部分切除術(shù)優(yōu)于擴大喉次全切除術(shù)RR為0.62,95%CI為(0.42,0.93)。垂直半喉切除術(shù)優(yōu)于喉次全切除術(shù),RR為0.44,95%CI為(0.28,0.70)。 喉部分切除患者生存質(zhì)量優(yōu)于喉全切除患者。喉聲門上水平部分切除術(shù)后嗓音質(zhì)量優(yōu)于喉垂直部分切除術(shù)和3/4喉部分切除術(shù)。納入研究均未比較不同術(shù)式患者的局部控制率。 (2)單純開放性喉切除術(shù)組與單純CO2激光手術(shù)組患者局部控制率、總生存率和嗓音質(zhì)量差異無統(tǒng)計學意義,納入研究均未比較患者的生存質(zhì)量。 (3)單純開放性喉切除術(shù)組與單純放療組比較,低劑量放療組患者3年局部控制率較單純開放性喉切除術(shù)組差,差異有統(tǒng)計學意義,RR為0.37,95%CI為(0.22,0.61)。患者的總生存率、生存質(zhì)量及嗓音質(zhì)量差異均無統(tǒng)計學意義。 (4)單純CO2激光手術(shù)組與單純放療組患者局部控制率、總生存率、嗓音質(zhì)量差異均無統(tǒng)計學意義,研究未比較術(shù)后患者生存質(zhì)量。 (5)單純開放性喉切除術(shù)組生存質(zhì)量優(yōu)于手術(shù)加術(shù)后放療組。單純開放性喉切除術(shù)組與手術(shù)加術(shù)后放療組患者治療局部控制率、總生存率、嗓音質(zhì)量差異均無統(tǒng)計學意義。 (6)單純開放性喉切除術(shù)組與術(shù)前放療加手術(shù)組患者治療后總生存率差異均無統(tǒng)計學意義,未比較局部控制率、生存質(zhì)量及嗓音質(zhì)量。 (7)術(shù)前放療加手術(shù)組與單純放療組總生存率差異均無統(tǒng)計學意義,未比較局部控制率、生存質(zhì)量及嗓音質(zhì)量。 (8)術(shù)前放療加手術(shù)組與手術(shù)加術(shù)后放療組總生存率差異均無統(tǒng)計學意義,未比較局部控制率、生存質(zhì)量及嗓音質(zhì)量。 (9)手術(shù)加術(shù)后放療組與單純放療組局部控制率、總生存率差異均無統(tǒng)計學意義,未比較生存質(zhì)量和嗓音質(zhì)量。 結(jié)論:現(xiàn)有研究顯示(1)系統(tǒng)評價結(jié)果顯示:低劑量放療后患者生存率較單純手術(shù)差;喉部分切除患者生存質(zhì)量較喉全切除患者優(yōu);放療對患者術(shù)后生存質(zhì)量有一定的影響;早期聲門型喉癌采用單純CO2激光手術(shù)和單純放療均可取得較好的療效,治療后患者生存率及嗓音質(zhì)量相似。(2)目前臨床上喉癌外科治療的術(shù)式較多,針對不同分期分型的喉癌采用不同的術(shù)式,喉癌治療的療效參差不齊,文獻設(shè)計類型以回顧性研究為主,隨機對照試驗數(shù)量有限。(3)目前尚缺少高質(zhì)量的隨機對照試驗,臨床上應(yīng)加強大樣本高質(zhì)量的對不同分期分型喉癌治療的隨機對照試驗,為喉癌的治療提供更加可靠合理的循證依據(jù)。 目的:在蛋白水平和基因水平檢測TopoⅡ-α在喉癌中的表達,了解TopoⅡ-α表達與喉癌臨床特征的相關(guān)性,探討TopoⅡ-α在喉癌發(fā)生、發(fā)展及預后中的作用,為喉癌生物學治療提供理論依據(jù)。 方法:提取病例資料齊全的77例喉鱗癌患者的組織蠟塊進行研究。其中22例包含喉癌組織及癌旁正常組織,55例未包含癌旁組織。采用免疫組化和免疫熒光法對22例喉癌及癌旁正常組織中的TopoⅡ-α蛋白進行定性、定量測定,分析其在癌旁不同距離組織中的表達變化。采用組織芯片技術(shù)將55例未包含癌旁組織的蠟塊制作成組織芯片,運用熒光原位雜交方法檢測組織芯片中TopoⅡ-α基因擴增及17號染色體倍體性的情況。采用SPSS15.0軟件進行統(tǒng)計學分析,χ2檢驗或Fisher確切概率法比較TopoⅡ-α蛋白在喉癌不同臨床分型、不同T、N分期及不同分化程度之間的表達差異,并比較TopoⅡ-α蛋白表達陰性與陽性組中基因擴增及17號染色體倍體性的情況。TopoⅡ-α蛋白陽性率與基因擴增及17號染色體倍體性之間的關(guān)聯(lián)分析采用Spearman法,以P0.05為差異有統(tǒng)計學意義。 結(jié)果:(1)在組織芯片蠟塊中,由于未取到鱗癌組織或者所取鱗癌組織很少,5例組織無法進行有效分析,有2例組織處理掉片,共48例組織可以進行有效分析。(2)TopoⅡ-α蛋白在喉癌組織中陽性率為71.43%(50/70),明顯高于喉黏膜正常組織中陽性率10%。(3)中分化+低分化組TopoⅡ-α蛋白陽性率明顯高于高分化組,差異有統(tǒng)計學意義(χ2=23.58,P0.05)。(4)T3+T4組TopoⅡ-α蛋白陽性率明顯高于T1+T2組,差異有統(tǒng)計學意義(χ2=3.92,P0.05)。(5)分別比較聲門上型、聲門型、聲門下型三組中TopoⅡ-α蛋白陽性率,差異均無統(tǒng)計學意義(χ2=1.16,P0.05)。(6)頸淋巴結(jié)轉(zhuǎn)移組與淋巴結(jié)未轉(zhuǎn)移組中TopoⅡ-α蛋白陽性率比較,差異無統(tǒng)計學意義(χ2=2.13,P0.05)。(7)從癌組織到逐漸遠離癌組織的癌旁組織中,TopoⅡ-α蛋白表達逐漸減少,在喉癌旁組織0.3-0.5cm的范圍內(nèi),TopoⅡ-α蛋白表達顯著變化。(8)喉癌中TopoⅡ-α蛋白表達量與與基因擴增狀態(tài)之間無相關(guān)性(r=0.15,P0.05);TopoⅡ-α蛋白表達量與17號染色體的倍體異常率正相關(guān)(r=0.44,P0.05),隨著17號染色體的倍體異常率的增高,TopoⅡ-α蛋白表達量也相應(yīng)增加。 結(jié)論:TopoⅡ-α蛋白表達水平與腫瘤臨床分期及分化程度等臨床特征有關(guān),可作為判斷預后的指標之一。TopoⅡ-α在喉癌發(fā)生、發(fā)展中起著重要作用,通過對TopoⅡ-α蛋白及基因的檢測可以對喉癌預后的評估和為生物治療腫瘤提供一定的科學依據(jù)。
[Abstract]:Objective: To evaluate the efficacy of simple surgery, surgery and radiotherapy in the treatment of larynx cancer by means of systematic evaluation, and provide evidence-based evidence for rational treatment of laryngeal carcinoma.
Methods: according to the method of Cochrane system evaluation, we systematically retrieved Cochrane library, Medline, Embase, Chinese biomedical database (CBM), Chinese journal full text database (CNKI) and other domestic and foreign authoritative databases on laryngectomy for laryngectomy, open laryngectomy, simple CO2 laser surgery, pure CO2 laser surgery, and pure CO2 laser surgery. The survival rate, the quality of life and the voice quality were compared between radiotherapy, preoperative radiotherapy plus surgery and postoperative radiotherapy. Revman5.0.17 was used to perform Meta analysis on the documents which were in conformity with the inclusion criteria. The two classification variables in the quantitative data were measured by RR and 95%CI, and the qualitative data were analyzed by descriptive analysis. The time ended in March 31, 2011.
Results: according to the retrieval strategy, 63 articles were included, including 7 randomized controlled trials, 1 prospective non randomized controlled trials, and the rest were retrospective study. The study was divided into 9 comparative groups. The results showed that:
(1) a total of 8 articles were compared for different surgical procedures of open laryngectomy. The survival rate of.A:3 years was not described in each group: the total survival rate of 3 years was 85.88% (949/1105). The laryngeal fissure vocal cord resection was superior to the supra glottal partial laryngectomy, and the vertical partial laryngectomy and the near total laryngectomy RR were 0, respectively. .28,0.14,0.23,95%CI (0.10,0.78), (0.04,0.50), (0.08,0.66).B:5 year survival rate: 5 year total survival rate was 73.19% (685/899). Laryngeal fissure vocal cord resection was superior to lateral vertical partial laryngectomy, supra glottal partial laryngectomy, horizontal vertical laryngectomy and near total laryngectomy, and RR for 0.37,0.27,0.25,0.23,95%CI (0.1). 8,0.75), (0.14,0.51), (0.12,0.50), (0.08,0.72). Vertical hemiclaryngectomy, horizontal half laryngectomy and laryngeal subtotal excision were superior to total laryngectomy, RR was 0.26,0.22,0.45,95%CI (0.13,0.51), (0.07,0.68), (0.23,0.87).C:10 year survival rate: 10 years total survival rate was 54.29% (177/326). Laryngeal fissure vocal cord resection was superior to anterior laryngectomy, Partial partial laryngectomy, horizontal vertical laryngectomy, extended partial laryngectomy and total laryngectomy, RR 0.34,0.34,0.38,0.28,0.34,95%CI (0.14,0.87), (0.15,0.81), (0.16,0.94), (0.12,0.65), (0.17,0.66). Vertical hemiclaryngectomy and horizontal hemiclaryngectomy are superior to total laryngectomy, RR is 0.45,0.49,95%CI (0.28,0.73), (0.26,0.93). Lateral vertical partial laryngectomy is superior to extended laryngectomy with RR 0.62,95%CI (0.42,0.93). Vertical semi laryngectomy is superior to subtotal laryngectomy, and RR is 0.44,95%CI (0.28,0.70).
The quality of life of the patients with partial laryngectomy is better than that of total laryngectomy. The quality of voice after partial laryngectomy is better than that of vertical partial laryngectomy and 3/4 partial laryngectomy.
(2) there was no significant difference in the local control rate, the total survival rate and the voice quality difference between the simple open laryngectomy group and the simple CO2 laser operation group, and the quality of life of the patients was not compared.
(3) compared with the simple radiotherapy group, the 3 year local control rate of the patients in the low dose radiotherapy group was less than that of the simple open laryngectomy group. The difference was statistically significant, the RR was 0.37,95%CI (0.22,0.61). The total survival rate, the quality of life and the difference of voice quality were not statistically significant.
(4) there was no significant difference in local control rate, total survival rate and voice quality difference between the simple CO2 laser operation group and the simple radiotherapy group. The study did not compare the quality of life of the patients after the operation.
(5) the quality of life in the simple open laryngectomy group was better than that of the operation plus postoperative radiotherapy group. There was no significant difference in the local control rate, the total survival rate and the voice quality difference between the simple open laryngectomy group and the operation plus postoperative radiotherapy group.
(6) there was no significant difference in the total survival rate between the simple open laryngectomy group and the preoperative radiotherapy plus surgery group, and there was no local control rate, quality of life and voice quality.
(7) there was no significant difference in the overall survival rate between preoperative radiotherapy plus surgery group and radiotherapy alone group. There was no significant difference in local control rate, quality of life and voice quality.
(8) there was no significant difference in overall survival rate between preoperative radiotherapy plus operation group and postoperative radiotherapy group. There was no significant difference in local control rate, quality of life and voice quality.
(9) there was no significant difference in the local control rate and the overall survival rate between the surgery plus radiotherapy group and the radiotherapy alone group, with no significant difference in quality of life and voice quality.
Conclusion: the present study showed that (1) the results of systematic evaluation showed that the survival rate of the patients after low dose radiotherapy was worse than that of the simple operation; the survival quality of the patients with laryngectomy was better than that of the total laryngectomy, and the radiotherapy had a certain influence on the quality of life after the operation, and the early glottic laryngectomy with simple CO2 laser surgery and simple radiotherapy could be better. The survival rate and voice quality were similar after treatment. (2) there were many surgical treatments for larynx cancer at present. Different surgical procedures were used for laryngocarcinoma in different stages. The curative effect of larynx cancer treatment was uneven. The literature design type was based on retrospective study, and the number of controlled trials was limited. (3) there is still lack of high quality at present. Randomized controlled trials should strengthen randomized controlled trials of large sample and high quality treatment for different stages of larynx cancer, and provide more reliable evidence for the treatment of larynx cancer.
Objective: to detect the expression of Topo II - alpha in laryngeal carcinoma at the protein level and gene level, to understand the correlation between the expression of Topo II - alpha and the clinical characteristics of laryngeal carcinoma, and to explore the role of Topo II - alpha in the occurrence, development and prognosis of laryngeal carcinoma, and provide a theoretical basis for the biological treatment of larynx cancer.
Methods: 77 cases of laryngeal squamous cell carcinoma were extracted from 77 cases of laryngeal squamous cell carcinoma. 22 of them included laryngeal carcinoma tissue and normal tissue adjacent to cancer, 55 cases were not included in para cancerous tissue. Immunohistochemistry and immunofluorescence were used to determine the quality of Topo II - alpha egg white in 22 cases of larynx cancer and normal tissues adjacent to cancer. Expression changes in different distance tissues. Tissue chip technology was used to make 55 paraffin blocks without paracancerous tissues into tissue chips. The fluorescence in situ hybridization was used to detect Topo - II - alpha gene amplification and chromosome 17 ploidy in tissue chips. SPSS15.0 software was used for statistical analysis, chi chi 2 test, or Fisher exact probability Ratio method was used to compare the expression differences of Topo II - alpha protein in different clinical types of laryngeal carcinoma, different T, N staging and differentiation, and compared the correlation of the positive rate of.Topo II - alpha protein with gene amplification and chromosome 17 ploidy in the negative and positive group of Topo II - alpha protein and the chromosome ploidy of 17 Analysis using Spearman method, P0.05 as the difference was statistically significant.
Results: (1) in the tissue chip wax block, 5 tissues could not be effectively analyzed because of the lack of squamous carcinoma tissue or the squamous cell carcinoma tissue. There were 2 cases of tissue processing and 48 tissues could be effectively analyzed. (2) the positive rate of Topo II - alpha protein in the larynx tissues was 71.43% (50/70), which was significantly higher than that in the normal tissues of the larynx. The positive rate of Topo II - alpha protein in 10%. (3) and low differentiation group was significantly higher than that in the high differentiation group (x 2=23.58, P0.05). (4) the positive rate of Topo II - alpha protein in T3+T4 group was significantly higher than that in the T1+T2 group, and the difference was statistically significant (5) compared to the supra glottic, glottic and subglottic three groups of Topo II - alpha protein, respectively. The positive rate was not statistically significant (x 2=1.16, P0.05). (6) there was no significant difference in the positive rate of Topo II - alpha protein in the cervical lymph node metastasis group and the non metastatic lymph node group (x 2=2.13, P0.05). (7) the expression of Topo - a protein in the paracancerous tissue from the cancer tissue to the gradually far away from the cancer tissue, the expression of Topo - a protein was gradually reduced, and the 0.3-0.5cm was organized near the larynx cancer. The expression of Topo II - alpha protein was significantly changed. (8) there was no correlation between Topo - II - alpha protein expression and gene amplification state (r=0.15, P0.05) in larynx cancer. The expression of Topo - II - alpha protein was positively correlated with the ploidy abnormal rate of chromosome 17 (r=0.44, P0.05), and the expression of Topo - A - alpha protein with the increase of chromosome ploidy rate of chromosome 17 It also increases accordingly.
Conclusion: the level of Topo - II - alpha protein expression is related to clinical features of tumor clinical stage and differentiation, which can be used as one of the indicators to judge the prognosis..Topo II - alpha plays an important role in the development of larynx cancer. The detection of Topo - II - alpha protein and gene can provide a certain family for the assessment of larynx cancer and the biological treatment of tumor. Learn the basis.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：博士
【學位授予年份】：2011
【分類號】：R739.65

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3 周q，

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