本文選題：食管胃結(jié)合部腺癌 + Siewert分型��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:分析食管胃結(jié)合部腺癌(adenocarcinoma of the esophagogastric junction,AEG)病理組織學(xué)標(biāo)本切緣陽(yáng)性的臨床病理特征及影響因素,為原發(fā)腫瘤(gross tumor volume,GTV)外擴(kuò)至CTV的合理范圍提供臨床參考。方法:收集2006年1月至2010年12月于河北醫(yī)科大學(xué)第四醫(yī)院行手術(shù)的AEG患者1371例。包括SiewertⅠ型84例,SiewertⅡ型612例,SiewertⅢ型675例。病理分期ⅠA期94例,ⅠB期89例,ⅡA期63例,ⅡB期368例,ⅢA期318例,ⅢB期251例,ⅢC期133例,Ⅳ期55例。分析不同臨床病理特征與切緣陽(yáng)性的關(guān)系,探討AEG術(shù)后切緣陽(yáng)性的影響因素。收集2016年11月至2017年1月期間10例局部進(jìn)展期AEG手術(shù)患者,術(shù)中探查腫瘤上下邊界,沿食管方向在體測(cè)量正常組織上切緣長(zhǎng)度,沿胃小彎方向在體測(cè)量正常組織下切緣長(zhǎng)度,進(jìn)行記錄后手術(shù)切除。切除后標(biāo)本固定24小時(shí),測(cè)量標(biāo)本固定后病理切片上、下切緣正常組織收縮比例。根據(jù)收縮比回推1371例AEG病理標(biāo)本正常組織切除長(zhǎng)度與切緣陽(yáng)性的關(guān)系,應(yīng)用受試者工作曲線(Receiver operator characteristic curve,ROC曲線)對(duì)其進(jìn)行界值限定,推算切緣陽(yáng)性率較高的分界點(diǎn)。結(jié)果:1切緣狀況全組切緣陽(yáng)性率9.4%(129/1371);其中單純上切緣陽(yáng)性52例,占切緣陽(yáng)性總數(shù)的40.3%(52/129);單純下切緣陽(yáng)性57例,占切緣陽(yáng)性總數(shù)的44.2%(57/129);上下切緣陽(yáng)性20例,占切緣陽(yáng)性總數(shù)的15.5%(20/129)。2收縮比AEG病理標(biāo)本制成病理大切片后進(jìn)行,上切緣平均收縮為術(shù)中長(zhǎng)度的36±4%;腫瘤長(zhǎng)徑平均收縮為術(shù)中長(zhǎng)度的70±5%;下切緣平均收縮為術(shù)中長(zhǎng)度的45±8%。3上切緣陽(yáng)性發(fā)生規(guī)律及其影響因素3.1 AEG上切緣切除范圍與上切緣陽(yáng)性率上切緣陽(yáng)性率5.3%(72/1371)。經(jīng)roc曲線分析顯示上切緣距離0.9cm為界值,上切緣距離0.9cm切緣陽(yáng)性率明顯低于上切緣距離≤0.9cm的發(fā)生率(4.6%vs.9.7%,c2=8.471,p=0.004)。以收縮比36%回推至人體內(nèi)的實(shí)際長(zhǎng)度,上切緣陽(yáng)性率較高的切除界值為2.5cm。3.2siewert各分型上切緣切除范圍與上切緣陽(yáng)性率1)siewertⅠ型患者上切緣陽(yáng)性率6.0%(5/84)。經(jīng)roc曲線分析顯示上切緣距離0.25cm為界值,上切緣距離0.25cm切緣陽(yáng)性率與上切緣距離≤0.25cm的發(fā)生率無(wú)顯著差異(4.1vs.20%,c2=1.660,p=0.198)。經(jīng)roc曲線無(wú)法分析出上切緣陽(yáng)性率較高的界值。2)siewertⅡ型患者上切緣陽(yáng)性率4.6%(28/612)。經(jīng)roc曲線分析顯示上切緣距離1.25cm為界值,上切緣距離1.25cm切緣陽(yáng)性率明顯低于上切緣距離≤1.25cm的發(fā)生率(2.5vs.8.8%,c2=12.650,p=0.000)。以收縮比36%回推至人體內(nèi)的實(shí)際長(zhǎng)度,上切緣陽(yáng)性率較高的切除界值為3.5cm。3)siewertⅢ型患者上切緣陽(yáng)性率5.8%(39/675)。經(jīng)roc曲線分析顯示上切緣距離0.25cm為界值,上切緣距離0.25cm切緣陽(yáng)性率與上切緣距離≤0.25cm的發(fā)生率無(wú)顯著差異(5.2vs.12.3%,c2=3.619,p=0.057)。經(jīng)roc曲線無(wú)法分析出上切緣陽(yáng)性率較高的界值。3.3影響上切緣陽(yáng)性的單因素及多因素分析單因素分析顯示腫瘤病理類型、分化程度、腫瘤最大徑、脈管癌栓、手術(shù)入路、手術(shù)方式、淋巴結(jié)轉(zhuǎn)移、上切緣切除距離是上切緣陽(yáng)性的影響因素(p0.05)。多因素分析顯示病理類型、分化程度、脈管癌栓是上切緣陽(yáng)性的獨(dú)立影響因素(p0.05)。4下切緣陽(yáng)性發(fā)生規(guī)律及其影響因素4.1aeg下切緣切除范圍與下切緣陽(yáng)性率下切緣陽(yáng)性率5.6%(77/1371)。經(jīng)roc曲線分析顯示下切緣距離1.1cm為界值,下切緣距離1.1cm切緣陽(yáng)性率明顯低于下切緣距離≤1.1cm的發(fā)生率(4.1%vs.12.1%,c2=25.035,p=0.000)。以收縮比45%回推至人體內(nèi)的實(shí)際長(zhǎng)度,下切緣陽(yáng)性率較高的切除界值為2.4cm。4.2siewert各分型下切緣切除范圍與下切緣陽(yáng)性率1)siewertⅠ型下切緣陽(yáng)性率為4.8%(4/84)。經(jīng)roc曲線分析顯示下切緣距離1.25cm為界值,下切緣距離1.25cm切緣陽(yáng)性率明顯低于下切緣距離≤1.25cm的發(fā)生率(1.4vs.20%,c2=5.707,p=0.017),以收縮比45%回推至人體內(nèi)的實(shí)際長(zhǎng)度,下切緣陽(yáng)性率較高的切除界值為2.8cm。2)siewertⅡ型下切緣陽(yáng)性率為5.7%(35/612)。經(jīng)roc曲線分析顯示下切緣距離1.20cm為界值,下切緣距離1.20cm切緣陽(yáng)性率明顯低于下切緣距離≤1.20cm的發(fā)生率(4.2vs.13.1%,c2=13.046,p=0.000),以收縮比45%回推至人體內(nèi)的實(shí)際長(zhǎng)度,下切緣陽(yáng)性率較高的切除界值為2.7cm。3)siewertⅢ型下切緣陽(yáng)性率為5.6%(38/675)。經(jīng)roc曲線分析顯示下切緣距離1.75cm為界值,下切緣距離1.75cm切緣陽(yáng)性率明顯低于下切緣距離≤1.75cm的發(fā)生率(4.2vs.10.4%,c2=8.509,p=0.004)。以收縮比45%回推至人體內(nèi)的實(shí)際長(zhǎng)度,下切緣陽(yáng)性率較高的切除界值為3.9cm。4.3影響下切緣陽(yáng)性的單因素及多因素分析單因素分析顯示腫瘤病理類型、分化程度、borromann分型、腫瘤最大徑、脈管癌栓、手術(shù)入路、淋巴結(jié)轉(zhuǎn)移、下切緣切除距離是下切緣陽(yáng)性的影響因素(p0.05)。多因素分析顯示病理類型、分化程度、borromann分型、腫瘤最大徑、脈管癌栓、手術(shù)入路、淋巴結(jié)轉(zhuǎn)移、下切緣切除距離是下切緣陽(yáng)性的獨(dú)立影響因素(p0.05)。結(jié)論:1病理類型、分化程度、脈管癌栓是上切緣陽(yáng)性的獨(dú)立影響因素;病理類型、分化程度、borromann分型、腫瘤最大徑、脈管癌栓、手術(shù)入路、淋巴結(jié)轉(zhuǎn)移、下切緣切除距離是下切緣陽(yáng)性的獨(dú)立影響因素。2aeg放射治療時(shí)ctv在gtv范圍向上外擴(kuò)2.5cm,向下外擴(kuò)2.5cm可能是較為合適的范圍。3siewertⅠ型患者ctv靶區(qū)在gtv范圍向下外擴(kuò)3.0cm可能是較為合適的范圍,向上外擴(kuò)需進(jìn)一步探討。siewertⅡ型患者ctv靶區(qū)在gtv范圍向上外擴(kuò)3.5cm,向下外擴(kuò)3.0cm可能是較為合適的范圍。siewertⅢ型患者ctv靶區(qū)在gtv范圍向下外擴(kuò)4.0cm可能是較為合適的范圍,向上外擴(kuò)需進(jìn)一步探討。
[Abstract]:Objective: to analyze the clinicopathological features and influencing factors of the positive margin of the histopathological specimens of adenocarcinoma of the esophagogastric junction (AEG), and to provide a clinical reference for the rational range of the primary tumor (gross tumor volume, GTV) to CTV. Methods: from January 2006 to December 2010 in Hebei medicine. 1371 cases of AEG patients in the fourth hospital of the University included 84 cases of Siewert I, 612 cases of Siewert II, 675 cases of type Siewert III, pathological stage I A stage, 89 cases, 63 cases of stage II A, 368 cases of stage II A, 318 cases of stage III A, 318 cases of stage III A, 251 cases in stage III B, 133 cases in stage III B, 133 cases in stage III C, and the relationship between different clinicopathological features and margin positive, and discuss AEG surgery. 10 cases of local progressive AEG operation from November 2016 to January 2017 were collected, and the upper and lower boundary of the tumor was detected during the operation. The length of the cutting edge was measured in the direction of the normal tissue in the direction of the esophagus, and the length of the cutting edge under the normal tissue was measured along the small direction of the stomach in the direction of the stomach. The resection was performed after the resection. The specimens were fixed 2 after the resection. After 4 hours, the normal tissue contraction ratio of the lower cutting edge was measured on the pathological sections after the specimen was fixed. According to the contraction ratio, the relationship between the normal tissue resection length and the positive margin of the 1371 cases of AEG pathological specimens was calculated. The boundary value of the subjects was limited by the subjects' working curve (Receiver operator characteristic curve, ROC curve), and the positive rate of the cutting edge was calculated. Results: the positive rate of the cutting edge of the 1 cutting edge was 9.4% (129/1371), among which 52 cases were positive with positive marginal margin, 40.3% (52/129), 57 cases with positive marginal margin, 44.2% (57/129), 20 cases of upper and lower margin positive, and 15.5% (20/129).2 contraction of the positive total margin of the cutting margin, AEG pathological specimen system The average contraction of the upper cutting edge was 36 + 4% in the length of the operation, the average contraction of the length of the tumor was 70 + 5% in the length of the operation, the average contraction of the lower cutting edge was 45 + 8%.3, and the positive rate of the upper margin resection margin and the positive margin of the upper margin 5.3% (72/1371) was 5.3% (72/1371). The ROC curve analysis showed that the upper margin of the edge distance was 0.9CM as the boundary value, the positive rate of the upper margin of the 0.9CM cutting edge was lower than that of the upper margin of the marginal distance less than 0.9CM (4.6%vs.9.7%, c2=8.471, p=0.004). The shear margin of the upper margin was higher than that of the 36% back to the human body. The positive rate of the upper margin of Siewert type I was 6% (5/84). The ROC curve analysis showed that the upper margin of the upper margin was bounded by 0.25cm. There was no significant difference (4.1vs.20%, c2=1.660, p= 0.198) between the positive rate of the upper margin of the cutting edge and the distance less than 0.25cm at the upper margin of the cutting edge (4.1vs.20%, c2=1.660, p= 0.198). The positive rate of the upper margin of the upper margin could not be analyzed by the ROC curve. The positive rate of the upper margin of the upper margin of Siewert II patients was 4.6% (28/612). The ROC curve analysis showed that the upper margin of the upper margin was bounded by 1.25cm, and the positive rate of the upper margin of the margin 1.25cm margin was significantly lower than that of the upper marginal distance less than 1.25cm (2.5vs.8.8%, c2=12.650, p=0.000). The positive rate of the upper margin was positive with the contraction ratio of the margin to the human body. The positive rate of upper margin of Siewert III patients was 5.8% (39/675). The ROC curve analysis showed that the upper margin of the upper margin was bounded by 0.25cm, and there was no significant difference between the positive rate of the upper margin and the distance between the upper margin of the tangent margin and the upper margin less than 0.25cm (5.2vs.12.3%, c2= 3.619, p=0.057). The upper margin could not be analyzed by the ROC curve. The single factor and multiple factor analysis of upper marginal value.3.3 affected the positive upper margin. Single factor analysis showed that the tumor pathological type, the degree of differentiation, the maximum diameter of the tumor, the vascular tumor thrombus, the surgical approach, the mode of operation, the lymph node metastasis, the distance of the excision margin were the positive factors of the upper margin (P0.05). The multivariate analysis showed the pathological type. The degree of vascular cancer embolus was an independent influence factor (P0.05) of the upper margin (P0.05).4, the positive rate of the lower margin of the cutting edge and its influence factors were 5.6% (77/1371) under the positive rate of the lower cutting edge and the lower cutting edge. The ROC curve analysis showed that the lower margin of the lower margin 1.1cm was a boundary value, and the positive rate of the lower margin of the lower margin of the 1.1cm margin was obviously lower than that of the lower margin of the lower margin. The incidence of cutting edge distance less than 1.1cm (4.1%vs.12.1%, c2=25.035, p=0.000). With the actual length of contraction compared to 45% back to the human body, the resection boundary value of the lower cutting edge was higher than that of the lower cutting margin and the lower margin of the lower cutting edge of the 2.4cm.4.2siewert. The positive rate of the lower margin of Siewert I was 4.8% (4/84). It was shown by ROC curve analysis. The positive rate of the cutting edge distance 1.25cm was lower than that of the lower cutting edge 1.25cm (1.4vs.20%, c2=5.707, p=0.017). The positive rate of the lower margin of the lower cutting edge was 2.8cm.2) and the positive rate of the lower margin of the lower margin was 5.7% (35/612). The ROC curve of the lower margin of the lower margin of the lower margin of the lower cutting edge was 45% (35/612). The analysis showed that the lower margin of the cutting edge was 1.20cm as the boundary value, the positive rate of the 1.20cm cutting edge of the lower cutting edge was significantly lower than that of the lower cutting edge (4.2vs.13.1%, c2=13.046, p=0.000), with the actual length of the contraction ratio of 45% back to the human body, the positive rate of the lower cutting edge of the resection boundary was 2.7cm.3) and the positive rate of the lower margin of the Siewert III type was 5.6% (38). /675). The ROC curve analysis showed that the cutting edge distance 1.75cm was the boundary value, the positive rate of the lower cutting edge of the 1.75cm cutting edge was lower than that of the lower cutting edge less than 1.75cm (4.2vs.10.4%, c2=8.509, p=0.004). The actual length of the contraction ratio was 45% back to the human body, and the high positive rate of the lower cutting edge was positive for the positive margin of the lower margin. Single factor and multiple factor analysis single factor analysis showed that tumor pathological type, differentiation degree, borromann typing, tumor maximum diameter, vascular tumor thrombus, surgical approach, lymph node metastasis, and lower margin resection distance were positive factors of lower cutting edge (P0.05). Multifactor analysis showed pathological type, differentiation degree, borromann typing, and tumor maximum diameter. Vascular tumor thrombus, surgical approach, lymph node metastasis, and lower cutting margin are independent influencing factors (P0.05). Conclusion: 1 pathological types, differentiation degree, vascular tumor thrombus are independent factors of positive upper margin; pathological type, differentiation degree, borromann typing, tumor maximum diameter, vascular tumor thrombus, surgical approach, lymph node metastasis, The distance of cutting edge excision is an independent influence factor of the positive lower margin of the edge of.2aeg. CTV expands 2.5cm in the GTV range, and 2.5cm may be a suitable range for.3siewert I in.3siewert I target area, CTV target area in GTV range down expansion may be a more suitable range. Further expand the need for.Siewert II type patient CT. The target area of V is expanded to 3.5cm in the range of GTV, and the downward extension of 3.0cm may be the more appropriate range of the CTV target area of.Siewert III patients in the GTV range. It may be a more suitable range to expand the 4.0cm. It will be further discussed.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 張佳佳;梁振威;李穎;王鑫;唐源;劉童瞳;馮燕茹;李寧;余靜;李帥;任驊;鄒霜梅;姜軍;韓偉;王維虎;王淑蓮;宋永文;劉躍平;房輝;劉新帆;余子豪;李曄雄;蔣力明;金晶;;SiewertⅡ型和Ⅲ型局部晚期胃食管交界處腺癌根治術(shù)后淋巴結(jié)復(fù)發(fā)規(guī)律分析[J];中華放射腫瘤學(xué)雜志;2016年04期

2 蔡杰;彭俊;王文憑;Y胂，

本文編號(hào)：1812800