發(fā)布時間：2018-02-05 22:37

  本文關(guān)鍵詞： 婚姻狀態(tài) 結(jié)腸腺癌 全因死亡率 腫瘤特異性死亡率 SEER數(shù)據(jù)庫　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究背景:結(jié)腸癌是男性第三常見、女性第二常見的惡性腫瘤,不管是發(fā)病率還是死亡率都非常高。結(jié)直腸癌患者的生存預(yù)后和很多因素相關(guān),如患者年齡、性別、種族、腫瘤部位、腫瘤分化程度、淋巴結(jié)狀態(tài)、腫瘤分期、分子病理或基因突變情況、治療策略、社會心理狀態(tài)等。既往研究發(fā)現(xiàn)婚姻狀態(tài)對結(jié)腸癌及其他癌癥的生存期有顯著影響,目前尚無婚姻狀態(tài)對結(jié)腸癌術(shù)后患者死亡率的影響的有關(guān)研究。研究目的:比較已婚結(jié)腸腺癌術(shù)后患者和非已婚結(jié)腸腺癌術(shù)后患者的生存預(yù)后。研究方法:本研究從美國SEER數(shù)據(jù)庫收集2004年至2009年期間進行了結(jié)腸癌手術(shù)的病例共了71,955例。首先利用Cox等比例回歸模型進行單因素、多因素分析,分析婚姻狀態(tài)對結(jié)腸癌術(shù)后患者死亡率的影響,并用Therneau-Grambsch試驗進行等比例假設(shè)檢驗。納入分析的變量包括:年齡、性別、種族、婚姻狀態(tài)、淋巴結(jié)率、腫瘤部位、腫瘤分化程度、TNM分期共8個變量。若有變量不滿足等比例假設(shè),改用Cox擴展模型分析婚姻狀態(tài)對結(jié)腸癌術(shù)后患者死亡率的影響。利用Fine-Gray競爭風險模型分析婚姻狀態(tài)對結(jié)腸癌術(shù)后患者結(jié)腸癌特異性死亡率的影響,在這個模型中其它原因的死亡被認為是競爭風險。研究結(jié)果:Cox擴展模型結(jié)果示,納入分析的八個變量都是結(jié)腸癌術(shù)后患者全因死亡率的獨立預(yù)測因子。非已婚結(jié)腸癌術(shù)后患者死亡的風險是已婚組的1.37倍,差異具有統(tǒng)計學意義(HR,1.37;95%CI,1.33-1.40;p0.001),且這個風險不隨時間改變而改變。Fine-Gray競爭風險模型結(jié)果示,非已婚組的結(jié)腸癌特異性死亡率比已婚組高20.7%,具有統(tǒng)計學差異(HR,1.21;95%CI,1.17-1.24;p0.001)。非已婚患者其他原因死亡率也顯著高于已婚患者,具有統(tǒng)計學差異(p0.001)。此外,腫瘤部位、腫瘤分化程度、性別、TNM分期不滿足等比例假設(shè)(P0.05),它們對全因死亡率的影響隨時間變化而變化。研究結(jié)論:婚姻狀態(tài)是結(jié)腸癌術(shù)后患者的一個非常有價值的預(yù)后指標。非已婚結(jié)腸癌術(shù)后患者的全因死亡率、結(jié)腸癌特異性死亡率、其他原因死亡率顯著高于已婚結(jié)腸癌術(shù)后患者。非已婚患者預(yù)后差的具體機制不明,可能與結(jié)直腸癌篩查率低、手術(shù)接受率低、輔助治療幾率低、姑息治療幾率低、心理壓力大有關(guān)。臨床醫(yī)生在給結(jié)腸癌患者提供個體化治療時,應(yīng)重視患者的婚姻狀態(tài),提高非已婚患者的治療積極性、依從性,也許他們的生存預(yù)后會有所改善。
[Abstract]:Background: colon cancer is the third most common malignant tumor in men and the second most common malignant tumor in women. Both morbidity and mortality are very high. The survival and prognosis of colorectal cancer patients are related to many factors such as age. Sex, race, tumor location, tumor differentiation, lymph node status, tumor staging, molecular pathology or gene mutation, treatment strategy. Previous studies have found that marital status has a significant impact on the survival of colon cancer and other cancers. There is no study on the effect of marital status on postoperative mortality of colon cancer patients. Objective: to compare the survival and prognosis of married patients with colon adenocarcinoma and those with nonmarried colon adenocarcinoma. This study collected 71 patients who underwent colon cancer surgery between 2004 and 2009 from the SEER database in the United States. 955 cases. First, univariate and multivariate analysis was carried out using Cox's proportional regression model to analyze the influence of marital status on postoperative mortality of colon cancer patients. The variables included age, sex, race, marital status, lymph node rate and tumor site. There were 8 variables of tumor differentiation and TNM stage. If there were variables which did not satisfy the equal proportion hypothesis. Cox extended model was used to analyze the effect of marital status on postoperative mortality of colon cancer patients. The Fine-Gray competitive risk model was used to analyze the specific mortality rate of colon cancer patients after colon cancer operation by using the Fine-Gray competitive risk model. The impact. Other causes of death in this model are considered to be competitive risks. The eight variables included in the analysis were independent predictors of all-cause mortality in postoperative colon cancer patients. The risk of death in non-married postoperative colon cancer patients was 1.37 times higher than that in married patients, and the difference was statistically significant. 1.37; 95 CII 1.33-1.40; The risk did not change over time. Fine-Gray 's competitive risk model showed that colon cancer specific mortality was 20.7% higher in the non-married group than in the married group. There was statistical difference in HR1. 21; 95 CIQ 1.17-1.24; The mortality rate of non-married patients was significantly higher than that of married patients (P 0.001). In addition, tumor location, tumor differentiation and sex were significantly higher in non-married patients than in married patients. The TNM stage was not satisfied with the equal proportion hypothesis (P0.05). Their effect on total mortality changes over time. Conclusion: marital status is a very valuable prognostic indicator for postoperative patients with colon cancer. The specific mortality rate of colon cancer was significantly higher than that of married patients after operation. The mechanism of poor prognosis in non-married patients was unclear, which may be associated with the low screening rate of colorectal cancer and the low acceptance rate of surgery. The clinical doctors should pay attention to the marital status of patients with colon cancer and improve the treatment enthusiasm of non-married patients when providing individualized treatment for colon cancer patients with low probability of adjuvant treatment, low probability of palliative treatment and great psychological pressure. Compliance may improve their survival and prognosis.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.35

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相關(guān)期刊論文 前1條

1 Giuseppe Verlato;Daniele Marrelli;Simone Accordini;Maria Bencivenga;Alberto Di Leo;Alberto Marchet;Roberto Petrioli;Giacomo Zoppini;Michele Muggeo;Franco Roviello;Giovanni de Manzoni;;Short-term and long-term risk factors in gastric cancer[J];World Journal of Gastroenterology;2015年21期

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本文編號：1492941