本文選題：子宮癌肉瘤 + 死亡�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：研究目的:通過meta分析,運(yùn)用循證醫(yī)學(xué)的方法綜合分析子宮癌肉瘤患者死亡的危險因素,間接反映疾病的預(yù)后,為臨床決策提供理論依據(jù)。研究方法:通過計算機(jī)系統(tǒng)檢索Pub Med、EMbase、Medline、Web of science等外文數(shù)據(jù)庫及中國知網(wǎng)(CNKI)、萬方數(shù)據(jù)庫、維普中文期刊全文數(shù)據(jù)庫、優(yōu)秀博碩士論文等中文數(shù)據(jù)庫,檢索時限截止至2016年12月31日,搜集所有與子宮癌肉瘤患者死亡危險因素相關(guān)的非隨機(jī)對照試驗、隨機(jī)對照試驗、隊列研究及病例對照研究,并追蹤納入文獻(xiàn)的參考文獻(xiàn)。語言限定為中文和英文。由2名研究人員根據(jù)納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)對文獻(xiàn)進(jìn)行獨(dú)立篩查、評價和資料提取。根據(jù)meta分析的要求對資料進(jìn)行收集和整理,應(yīng)用Rev Man5.3軟件進(jìn)行Meta統(tǒng)計分析。研究結(jié)果:本研究通過制定的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)對文獻(xiàn)進(jìn)行嚴(yán)格篩選,最終納入8篇文獻(xiàn),其中中文文獻(xiàn)6篇,英文文獻(xiàn)2篇。應(yīng)用Newcastle-Ottawa Scale(NOS量表)對文獻(xiàn)質(zhì)量進(jìn)行評價,均符合標(biāo)準(zhǔn)。對各因素納入的相應(yīng)研究進(jìn)行Meta分析,結(jié)果顯示(1)不同年齡分組的子宮癌肉瘤患者的死亡率無明顯差異;(2)腫瘤FIGO分期晚的子宮癌肉瘤患者死亡率高,且差異具有統(tǒng)計學(xué)意義(OR=0.11,95%CI[0.05,0.24],P0.00001);(3)腫瘤分化程度低的子宮癌肉瘤患者的死亡率高,且差異存在統(tǒng)計學(xué)意義(OR=0.09,95%CI[0.01,0.77],P=0.03);(4)腫瘤直徑大的子宮癌肉瘤患者的死亡率高,且差異有統(tǒng)計學(xué)意義(OR=0.23,95%CI[0.09,0.62],P=0.003);(5)癌性成分為子宮內(nèi)膜樣腺癌的子宮癌肉瘤患者的死亡率低,且差異具有統(tǒng)計學(xué)意義(OR=0.32,95%CI[0.11,0.95],P=0.04),敏感性分析顯示該結(jié)論敏感性高,可靠性差;(6)肉瘤成分不同的兩組子宮癌肉瘤患者的死亡率不存在明顯統(tǒng)計學(xué)差異;(7)子宮肌層浸潤程度深的子宮癌肉瘤患者的死亡率高,并且差異具有統(tǒng)計學(xué)意義(OR=0.11,95%CI[0.05,0.24],P0.00001);(8)術(shù)后殘余病灶直徑大的子宮癌肉瘤患者的死亡率高,且差異具有統(tǒng)計學(xué)意義(OR=0.07,95%CI[0.01,0.55],P=0.01);(9)有淋巴結(jié)轉(zhuǎn)移的子宮癌肉瘤患者的死亡率高,且差異具有統(tǒng)計學(xué)意義(OR=0.15,95%CI[0.06,0.37],P0.0001);(10)有淋巴脈管間隙浸潤(LVSI)的子宮癌肉瘤患者的死亡率高,且差異具有統(tǒng)計學(xué)意義(OR=0.28,95%CI[0.10,0.78],P=0.010.05),但敏感性分析顯示該結(jié)論敏感性較高,可靠性差;(11)術(shù)后輔助化療或術(shù)后輔助放療的兩組子宮癌肉瘤患者的死亡率無明顯統(tǒng)計學(xué)差異。研究結(jié)論:1、腫瘤FIGO分期晚、腫瘤分化程度低、腫瘤直徑大、子宮肌層浸潤程度深、術(shù)后有殘余病灶、有淋巴結(jié)轉(zhuǎn)移是子宮癌肉瘤患者死亡的危險因素。2、年齡、肉瘤成分不是子宮癌肉瘤患者死亡的危險因素。術(shù)后輔助化療和術(shù)后輔助放療對子宮癌肉瘤患者死亡的影響兩者無明顯差別。3、癌性成分為非子宮內(nèi)膜樣腺癌、存在淋巴脈管間隙浸潤(LVSI)可能是子宮癌肉瘤患者死亡的危險因素,但該結(jié)論可靠性差,需要更多研究證據(jù)的驗證。4、孕產(chǎn)次、絕經(jīng)情況、宮頸侵犯可能不是子宮癌肉瘤患者的死亡的危險因素,但本次研究納入的文獻(xiàn)數(shù)目均只有1篇,論證強(qiáng)度很小,可能導(dǎo)致統(tǒng)計分析結(jié)果存在較大誤差,研究結(jié)果需要更多高質(zhì)量、大樣本的研究提供可靠數(shù)據(jù)加以分析。
[Abstract]:Objective: through meta analysis, the risk factors of death in patients with uterine carcinosarcoma of the comprehensive analysis method of evidence-based medicine, indirectly reflect the prognosis of the disease, and provide a theoretical basis for clinical decision making. Methods: through computer retrieval system of Pub Med, EMbase, Medline, Web of science and Chinese HowNet database (CNKI). Wanfang database, VIP Chinese CNKI, Chinese dissertation database, retrieval time deadline to December 31, 2016, collect all the risk factors of uterine cancer and sarcoma death related non randomized controlled trials, randomized controlled trials, cohort study and case study, and tracking of literature reference language is defined as. Chinese and English. By 2 researchers according to inclusion criteria and exclusion criteria for independent evaluation and screening of the literature, the data were extracted according to the meta analysis. Requirements for the collection and collation of data, using Rev Man5.3 Meta software for statistical analysis. Results: the study by the inclusion and exclusion criteria rigorous screening of the literature, a total of 8 trials were included, of which 6 articles Chinese, English 2 references. The application of Newcastle-Ottawa Scale (NOS scale) to evaluate the quality conforms to the standard. The corresponding research into the factors of Meta analysis, the results showed no significant difference (1) uterine carcinosarcoma patients with different age group mortality; (2) the mortality rate for patients with sarcoma of uterine cancer tumor FIGO stage is high, and the difference was statistically significant (OR=0.11,95%CI[0.05,0.24], P0.00001) (; 3) a low degree of tumor differentiation in patients with uterine carcinosarcoma of the high mortality rate, and the difference wasstatistically significant (OR=0.09,95%CI[0.01,0.77], P=0.03); (4) the large diameter of the tumor of uterine cancer sarcoma patients The mortality rate is high, and the difference was statistically significant (OR=0.23,95%CI[0.09,0.62], P=0.003); (5) cancer components of uterine carcinosarcoma were endometrioid adenocarcinoma of the lower death rate, and the difference was statistically significant (OR=0.32,95%CI[0.11,0.95], P=0.04), sensitivity analysis shows that the conclusion of high sensitivity and reliability; (6) sarcoma different compositions of two groups of uterine carcinosarcoma mortality in patients with no obvious statistical difference; (7) uterine carcinosarcoma were deep myometrial invasion and high mortality, the difference has statistical significance (OR=0.11,95%CI[0.05,0.24], P0.00001); (8) postoperative residual tumor diameter in patients with large uterine carcinosarcoma and high mortality, and the difference was statistically significant (OR=0.07,95%CI[0.01,0.55], P=0.01); (9) with uterine carcinosarcoma patients with lymph node metastasis. The mortality rate is high, and the difference was statistically significant (OR=0.15,95 %CI[0.06,0.37], P0.0001); (10) lymph vascular space invasion (LVSI) of uterine sarcoma patients with high mortality, and the difference was statistically significant (OR=0.28,95%CI[0.10,0.78], P=0.010.05), but the sensitivity analysis shows that the conclusion of higher sensitivity, poor reliability; (11) radiotherapy and adjuvant chemotherapy or postoperative two groups of uterus carcinosarcoma of mortality in patients with no significant difference. Conclusion: 1, tumor FIGO stage, tumor differentiation, tumor diameter, myometrial invasion depth, postoperative residual lesions, lymph node metastasis is.2, the risk factors of death in patients with uterine carcinosarcoma of the age, the risk factors of death sarcoma no uterine carcinosarcoma patients. Adjuvant chemotherapy and postoperative adjuvant radiotherapy.3 no significant difference effect on mortality in patients with uterine carcinosarcoma both into cancer divided into non endometrioid adenocarcinoma, there are shower Pakistan vascular space invasion (LVSI) may be a risk factor for death in patients with carcinosarcoma of the uterus, but the reliability is poor, need more evidence to verify the.4, pregnancy, menopause, death risk factors of cervical invasion may not be cancer of the uterus sarcoma patients, but the number of documents in the study were only 1 that argument strength is very small, may cause a great error in the results of statistical analysis, the results need more high quality, large sample research to provide reliable data for analysis.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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