本文選題：惡性外周神經(jīng)鞘瘤　切入點：臨床病理特征　出處：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討惡性外周神經(jīng)鞘瘤(MPNST)患者的臨床病理特征及其預(yù)后因素。方法回顧性分析1999年1月至2016年1月中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院收治的140例MPNST患者的臨床資料,其中男性66例,女性74例,中位發(fā)病年齡40歲。生存分析采用Kaplan-Meier法,并行Log rank檢驗,多因素分析采用Cox比例風(fēng)險回歸模型。結(jié)果全組患者的中位隨訪時間為43個月,3年和5年生存率分別為56.4%和48.6%,3年局部復(fù)發(fā)率為42.9%,3年遠(yuǎn)處轉(zhuǎn)移率為49.3%。單因素分析顯示,MPNST患者的5年生存率與腫瘤部位、深度、AJCC分期、S-100的標(biāo)記狀況、Ki-67指數(shù)、手術(shù)切緣狀態(tài)以及是否放療有關(guān)(均P0.05)。MPNST患者的3年局部復(fù)發(fā)率與腫瘤部位、深度、AJCC分期、S-100標(biāo)記狀態(tài)、Ki-67指數(shù)、手術(shù)切緣狀態(tài)、是否放療、是否化療有關(guān)(均P0.05)。MPNST患者的3年遠(yuǎn)處轉(zhuǎn)移率與腫瘤部位、大小、深度、AJCC分期、S-100標(biāo)記狀況、Ki-67指數(shù)、手術(shù)切緣狀態(tài)有關(guān)(均P0.05)。多因素分析顯示,腫瘤AJCC分期、S-100標(biāo)記狀況是影響MPNST患者5年總生存的獨立因素(均P0.05)。腫瘤部位、Ki-67指數(shù)、是否化療是影響MPNST患者局部復(fù)發(fā)的獨立因素(均P0.05)。腫瘤深度、大小、AJCC分期、Ki-67指數(shù)是影響MPNST患者發(fā)生遠(yuǎn)處轉(zhuǎn)移的獨立因素(均P0.05)。結(jié)論MPNST患者的預(yù)后較差。影響MPNST患者預(yù)后的因素較多,腫瘤AJCC分期較晚、S-100陰性的患者5年生存率較低;腫瘤位于頭頸、Ki-67指數(shù)≥20%、未行化療的患者易復(fù)發(fā);腫瘤5cm、AJCC分期較晚、手術(shù)切緣陽性、Ki-67指數(shù)≥20%的患者易發(fā)生遠(yuǎn)處轉(zhuǎn)移。
[Abstract]:Objective to investigate the clinicopathological features and prognostic factors of malignant peripheral neurilemmoma (MPNST). Methods the clinical data of 140 MPNST patients admitted to the Cancer Hospital of the Chinese Academy of Medical Sciences from January 1999 to January 2016 were retrospectively analyzed, including 66 males. The median age of onset was 40 years old in 74 female patients. Survival analysis was performed with Kaplan-Meier method and Log rank test. Results the median follow-up time was 43 months, the 3-year and 5-year survival rates were 56.4% and 48.6 respectively, the 3-year local recurrence rate was 42.9%, and the 3-year distant metastasis rate was 49.3%. The 5-year survival rate and tumor site of patients with MPNST, The marked status of S-100 in AJCC staging was Ki-67 index, surgical margin status and whether radiotherapy was relevant (all P0.05. MPNST patients had 3 years local recurrence rate and tumor site, depth AJCC staging and S-100 labeled status of Ki-67 index, surgical margin status, radiotherapy or not. Whether chemotherapy-related (all P0.05, MPNST, 3-year distant metastasis rate was associated with tumor location, size, depth of AJCC staging and S-100 labeling status and Ki-67 index, surgical margin status were correlated (all P 0.05). Multivariate analysis showed that, S-100 labeling status in AJCC staging was an independent factor (all P 0.05) to affect the overall survival of MPNST patients in 5 years. Ki-67 index of tumor site and whether chemotherapy was an independent factor affecting local recurrence in MPNST patients (all P0.05. tumor depth). Ki-67 index was an independent factor influencing distant metastasis in patients with MPNST (P 0.05). Conclusion the prognosis of patients with MPNST is worse than that of patients with MPNST. The 5-year survival rate of patients with AJCC stage is lower than that of patients with negative AJCC staging. The tumor was located in the head and neck with Ki-67 index 鈮，

本文編號：1596341