本文選題：進(jìn)展期胃癌　切入點(diǎn)：淋巴結(jié)轉(zhuǎn)移　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移相關(guān)危險(xiǎn)因素,為進(jìn)展期胃癌患者綜合治療方案提供理論依據(jù)。方法:回顧性分析河北醫(yī)科大學(xué)第四醫(yī)院2010年1月至2015年12月期間收治的行胃癌根治手術(shù)治療并具有完整病例資料的進(jìn)展期胃癌(T_(2-4)N_(0-3)M_0)患者共計(jì)337例。應(yīng)用SPSS19.0統(tǒng)計(jì)軟件χ~2檢驗(yàn)分析性別、年齡、腫瘤部位、腫瘤大小、Borrmann分型、分化程度、浸潤(rùn)深度、脈管瘤栓、腫瘤標(biāo)記物、免疫組化指標(biāo)等對(duì)進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移的影響。為排除各種因素之間的相互作用,采用多因素非條件Logistic回歸分析對(duì)相關(guān)因素進(jìn)行分析,P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素單因素分析:1.1女性患者淋巴結(jié)轉(zhuǎn)移率明顯高于男性患者(χ~2=8.217,P=0.004)。1.2 CA-19927 U/m L患者淋巴結(jié)轉(zhuǎn)移率明顯高于CA-199≤27 U/m L者(χ~2=9.984,P=0.002);CA72-46.9 U/m L患者者淋巴結(jié)轉(zhuǎn)移率明顯高于CA72-4≤6.9 U/m L者(χ~2=8.676,P=0.003)。1.3腫瘤直徑≥4cm淋巴結(jié)轉(zhuǎn)移率明顯高于腫瘤直徑4cm的患者(χ~2=18.269,P=0.000);隨著T分期的增加,患者淋巴結(jié)轉(zhuǎn)移率明顯升高(χ~2=23.940,P=0.000);有脈管瘤栓患者的淋巴結(jié)轉(zhuǎn)移率明顯高于無(wú)脈管瘤栓者(χ~2=16.283,P=0.000);浸潤(rùn)型(BorrmannⅢ型、Ⅳ型)胃癌患者淋巴結(jié)轉(zhuǎn)移率明顯高于局限型(BorrmannⅠ型、Ⅱ型)患者(χ~2=4.063,P=0.044),但BorrmanⅠ、Ⅱ型之間和BorrmanⅢ、Ⅳ型之間的差異無(wú)顯著統(tǒng)計(jì)學(xué)意義(P0.05)。1.4血小板(P=0.624)、白蛋白(P=0.190)、NLR(P=0.793)、PLR(P=0.458)、FIB(P=0.466)與進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移差異均無(wú)統(tǒng)計(jì)學(xué)意義。1.5胃癌組織中EGFR(χ~2=5.076,P=0.024)、HER2(χ~2=5.089,P=0.024)、P53(χ~2=5.192,P=0.023)、TOPOⅡ(χ~2=4.546,P=0.033)的陽(yáng)性表達(dá)及Ki67高表達(dá)(χ~2=4.661,P=0.031)與進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移有關(guān)。2進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素多因素分析:CA-199水平(OR:0.267,(0.088-0.812);P=0.020)、CA72-4水平(OR:0.328,(0.124-0.865);P=0.024)、浸潤(rùn)深度(OR:1.891,(1.249-2.862);P=0.003)與進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移獨(dú)立相關(guān),而腫瘤大小、脈管瘤栓、Borrman分型等并非反應(yīng)進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移的獨(dú)立影響因素。結(jié)論:1進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移與CA-199水平、CA72-4水平、腫瘤大小、浸潤(rùn)深度、脈管瘤栓及Bormann分型密切相關(guān);CA-199、CA72-4水平越高、腫瘤的直徑≥4cm、T分期越晚、有脈管瘤栓、大體分型為浸潤(rùn)型(BorrmannⅢ型、Ⅳ型),則淋巴結(jié)轉(zhuǎn)移率越高。多因素分析中,CA-199、CA72-4水平及浸潤(rùn)深度為影響進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素。因此我們認(rèn)為術(shù)前將以上危險(xiǎn)因素進(jìn)行有效整合,可篩選出淋巴結(jié)轉(zhuǎn)移的高危人群,為胃癌患者的根治性決策提供參考。2胃癌組織中EGFR、HER2、P53、TOPOⅡ的陽(yáng)性表達(dá)及Ki67高表達(dá)與腫瘤的侵襲轉(zhuǎn)移有關(guān),可作為進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移高危因素的預(yù)測(cè)指標(biāo)。探究這一規(guī)律性,對(duì)預(yù)測(cè)進(jìn)展期胃癌淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)性、制定合理的綜合治療方案具有重要的意義。
[Abstract]:Objective: to investigate the risk factors of lymph node metastasis in advanced gastric cancer. Methods: to provide theoretical basis for comprehensive treatment of advanced gastric cancer patients. Methods: retrospective analysis of radical operation of gastric cancer from January 2010 to December 2015 in the fourth Hospital of Hebei Medical University. A total of 337 patients with advanced gastric cancer were collected. The SPSS19.0 statistical software 蠂 ~ 2 was used to test and analyze the sex. Age, tumor location, tumor size and Borrmann classification, degree of differentiation, depth of invasion, vascular embolus, tumor markers, immunohistochemical markers and other factors affect lymph node metastasis of advanced gastric cancer. Multivariate non-conditional Logistic regression analysis was used to analyze the related factors. (P0.05) the difference was statistically significant. Results the univariate analysis of the risk factors of lymph node metastasis of advanced gastric cancer in 1: 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. The lymph node metastasis rate in the patients with CA-19927 U / mL was significantly higher than that in the patients with CA-199 鈮，

本文編號(hào)：1675210