本文選題：結(jié)直腸腫瘤　切入點：淋巴結(jié)外腫瘤種植　出處：《青島大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：目的:探討結(jié)直腸癌患者淋巴結(jié)外腫瘤種植(ENTDs)的臨床病理學(xué)特征及其與預(yù)后的關(guān)系,從而指導(dǎo)患者臨床治療決策的選擇,進一步改善患者的預(yù)后。方法:1.采用單中心回顧性研究的方法,選取自2009年6月至2013年6月在青島大學(xué)附屬醫(yī)院普外科行手術(shù)治療的含有ENTDs的結(jié)直腸癌患者為研究對象,收集其臨床及病理資料,并對其進行隨訪,運用SPSS15.O統(tǒng)計學(xué)軟件進行統(tǒng)計分析,生存分析采用kaplan-Meier法計算,單因素預(yù)后分析采用Log-Rank法檢驗,多因素預(yù)后分析采用Cox風(fēng)險回歸模型分析。2.檢索1990至2014年MEDLINE/Pub Med、Web of Science、Directory of Open Access Journals(DOAJ)、Springer Link等15家國際文獻數(shù)據(jù)庫以及中國生物醫(yī)學(xué)文獻光盤數(shù)據(jù)庫、中國知網(wǎng)、萬方數(shù)據(jù)庫等中文數(shù)據(jù)庫有關(guān)結(jié)直腸癌患者ENTDs與患者術(shù)后生存率關(guān)系的研究文獻,按納入和排除標(biāo)準篩選文獻、提取資料和質(zhì)量評價后,采用Review-Manager5.3軟件進行Meta分析。結(jié)果:1.本研究伴有ENTDs的結(jié)直腸癌患者共64例,占同期結(jié)直腸癌患者的5.54%。當(dāng)ENTDs個數(shù)為1個時,其術(shù)后5年生存率為50%(24/44),術(shù)后中位生存時間為42.5月;當(dāng)ENTDs個數(shù)大于1個時,其術(shù)后5年生存率為22.2%(4/18),術(shù)后中位生存時間為38.0月。單因素分析結(jié)果顯示臨床形態(tài),組織學(xué)類型,T分期,N分期,M分期,脈管浸潤,周圍神經(jīng)浸潤,術(shù)前血清CEA,CA19-9,手術(shù)方式,輔助治療及ENTDs數(shù)目是伴ENTDs結(jié)直腸癌的預(yù)后影響因素。Cox回歸分析顯示腫瘤組織學(xué)類型、T分期及N分期是影響伴ENTDs結(jié)直腸癌預(yù)后的獨立危險因素。2.Meta分析共納入10篇文獻的4068例結(jié)直腸癌患者,其中有ENTDs者727例(ENTDs組),不存在ENTDs者3341例(對照組)。Meta分析結(jié)果顯示:ENTDs組的5年總生存率(OR=0.27,95%CI:0.18-0.43)和5年無復(fù)發(fā)生存率(OR=0.23,95%CI:0.16-0.34)均明顯低于對照組(均P0.00001);亞組分析顯示,淋巴結(jié)轉(zhuǎn)移陰性組(N0)及淋巴結(jié)轉(zhuǎn)移陽性組(N+)結(jié)直腸癌患者ENTDs組的5年總生存率均明顯低于對照組(均P0.05)。結(jié)論:1.伴ENTDs結(jié)直腸癌臨床大體類型以潰瘍型為主,浸潤型所占比例亦較高;組織學(xué)類型以腺癌為主;分化程度以中、低分化為主;TNM分期主要為Ⅲ期及Ⅳ期;大多數(shù)患者術(shù)前血清CEA和CA19-9升高。臨床形態(tài),組織學(xué)類型,T分期,N分期,M分期,脈管浸潤,周圍神經(jīng)浸潤,術(shù)前血清CEA,CA19-9,手術(shù)方式,輔助治療及ENTDs數(shù)目是伴ENTDs結(jié)直腸癌的預(yù)后影響因素。腫瘤組織學(xué)類型、T分期及N分期是影響伴ENTDs結(jié)直腸癌預(yù)后的獨立危險因素。2.ENTDs是結(jié)直腸癌患者的預(yù)后不良因素;ENTDs對結(jié)直腸癌患者術(shù)后生存率的影響可能類似于局部淋巴結(jié)轉(zhuǎn)移,或者介于淋巴結(jié)轉(zhuǎn)移和遠處轉(zhuǎn)移之間。
[Abstract]:Objective: to investigate the clinicopathological features of extralymph node tumor implants (ENTDs) in patients with colorectal cancer and their relationship with prognosis so as to guide the choice of clinical treatment decisions. Methods 1. Single center retrospective study was used to select colorectal cancer patients with ENTDs who underwent surgical treatment in general surgery department of Qingdao University Hospital from June 2009 to June 2013. The clinical and pathological data were collected and followed up. SPSS15.O software was used for statistical analysis, kaplan-Meier method was used for survival analysis, and Log-Rank method was used for univariate prognostic analysis. Multivariate prognostic analysis using Cox risk regression model analysis .2.Retrieval of 15 international literature databases, such as MEDLINE/Pub Med#en1# of Open Access Journals of Open Journals, Springer Link, and China Biomedical Literature CD-ROM database from 1990 to 2014. Chinese databases such as Wanfang database were used to study the relationship between ENTDs and postoperative survival rate of patients with colorectal cancer. The literature was screened according to the criteria of inclusion and exclusion, and the data was extracted and the quality was evaluated. Review-Manager5.3 software was used to analyze Meta. Results 1. 64 cases of colorectal cancer with ENTDs in this study, accounting for 5.54% of the patients with colorectal cancer. When the number of ENTDs was 1, the 5-year survival rate was 50% 24 / 44%, and the median survival time was 42.5 months. When the number of ENTDs was more than 1, the 5 year survival rate was 22. 2% / 18%, and the median survival time was 38. 0 months. The results of univariate analysis showed that the clinical morphology, histological type, T stage, N stage and M stage, vascular infiltration, peripheral nerve infiltration were observed. Preoperative serum CEA CA19-9, operative method, Adjuvant therapy and number of ENTDs were prognostic factors for colorectal cancer with ENTDs. Cox regression analysis showed that T stage and N stage were independent risk factors for prognosis of colorectal cancer with ENTDs. 2. Meta-analysis included 10 articles. Of 4068 patients with colorectal cancer, Among them, 727 cases with ENTDs and 3341 cases without ENTDs were significantly lower than those in the control group (all P 0.00001). The 5-year overall survival rate was 0.2795% (CI: 0.2795% 0.18-0.43) and the 5-year recurrence free survival rate was 0.2395% (all P0.00001) in the control group (all P0.00001), and the 5-year recurrence free survival rate of 0.2395 CIW 0.16-0.34 in the control group was significantly lower than that in the control group (P < 0.05). The 5-year overall survival rate in ENTDs group was significantly lower than that in control group (P < 0.05). Conclusion 1. The clinical gross types of colorectal cancer with ENTDs were mainly ulcerative type, and the overall survival rate in ENTDs group was significantly lower than that in control group (P < 0.05), both in lymph node metastasis negative group (n 0) and in lymph node metastasis positive group (n). The proportion of infiltrating type was also high, histologic type was adenocarcinoma, differentiation degree was middle and low differentiation, stage 鈪，

本文編號：1564918