本文選題：胃癌 + 淋巴結(jié)轉(zhuǎn)移比率�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：背景與目的:目前胃癌根治術(shù)后遠(yuǎn)期預(yù)后仍較差,因此,確定預(yù)測(cè)胃癌根治術(shù)后生存的相關(guān)指標(biāo)是非常重要的,在我們這個(gè)回顧性的研究中,我們探究了淋巴結(jié)轉(zhuǎn)移比率與Lauren分型對(duì)胃癌根治術(shù)后生存預(yù)測(cè)價(jià)值的研究,并且進(jìn)行了淋巴結(jié)轉(zhuǎn)移比率及Lauren分型相應(yīng)的亞組分析,對(duì)清掃淋巴結(jié)數(shù)目多少對(duì)預(yù)后的影響進(jìn)行了探究,比較了淋巴結(jié)轉(zhuǎn)移比率與淋巴結(jié)分期對(duì)預(yù)后評(píng)估的準(zhǔn)確性,分析了淋巴結(jié)轉(zhuǎn)移比率與Lauren分型之間的關(guān)系,并以淋巴結(jié)轉(zhuǎn)移比率作為預(yù)后指標(biāo)對(duì)Lauren分型各亞組進(jìn)行了進(jìn)一步深入探究。方法:回顧性分析了我院261例病理診斷明確的胃癌根治術(shù)后患者的臨床資料,運(yùn)用單因素Kaplan—Meier方法和多因素Cox回歸方法對(duì)納入標(biāo)準(zhǔn)的患者進(jìn)行了生存分析,用受試者工作特征曲線(ROC曲線)探究了淋巴結(jié)轉(zhuǎn)移比率(r N)分期與淋巴結(jié)分期(p N)對(duì)胃癌根治術(shù)后患者預(yù)后預(yù)測(cè)評(píng)估的準(zhǔn)確性。應(yīng)用壽命表法對(duì)淋巴結(jié)轉(zhuǎn)移比率分期各亞組的1年、3年、5年的生存率進(jìn)行了分析,應(yīng)用卡方檢驗(yàn)對(duì)淋巴結(jié)轉(zhuǎn)移比率與Lauren分型之間的關(guān)系進(jìn)行了深入的分析,應(yīng)用生存曲線和比例風(fēng)險(xiǎn)回歸Cox分析深入探究了以淋巴結(jié)轉(zhuǎn)移比率為預(yù)后指標(biāo)在Lauren分型各亞組之間的生存預(yù)后價(jià)值。結(jié)果:單因素分析顯示有意義的預(yù)后因素包括:腫瘤最大直徑(P0.001),淋巴結(jié)轉(zhuǎn)移比率(P0.001),Lauren分型(P0.001),淋巴結(jié)分期(p=0.001),TNM分期(P0.001),多因素分析顯示:腫瘤最大直徑(P=0.03),淋巴結(jié)轉(zhuǎn)移比率(P0.001),Lauren分型(P0.001),均是胃癌根治術(shù)后生存獨(dú)立的預(yù)測(cè)指標(biāo)。通過生存率分析還顯示淋巴結(jié)轉(zhuǎn)移比率分析越高預(yù)后越差,而且Lauren分型中彌漫型預(yù)后最差,ROC曲線分析確定了淋巴結(jié)轉(zhuǎn)移比率分期對(duì)胃癌術(shù)后預(yù)后生存的預(yù)測(cè)性較淋巴結(jié)分期更加準(zhǔn)確。卡方檢驗(yàn)分析示淋巴結(jié)轉(zhuǎn)移比率與Lauren分型之間無相互關(guān)聯(lián)因素,淋巴結(jié)轉(zhuǎn)移比率與Lauren分型均是胃癌根治術(shù)后獨(dú)立的預(yù)測(cè)因素,Lauren分型的亞組分析確定了淋巴結(jié)轉(zhuǎn)移比率可以作為獨(dú)立的預(yù)后指標(biāo)預(yù)測(cè)Lauren分型中彌漫型的患者生存。結(jié)論:淋巴結(jié)轉(zhuǎn)移比率與Lauren分型均是胃癌根治術(shù)后患者預(yù)后生存的獨(dú)立預(yù)測(cè)因素,淋巴結(jié)轉(zhuǎn)移比率分期越高預(yù)后越差,Lauren分型的三型中,彌漫型預(yù)后最差,淋巴結(jié)轉(zhuǎn)移比率分期對(duì)于胃癌根治術(shù)后患者預(yù)后生存的預(yù)測(cè)性優(yōu)于淋巴結(jié)分期。淋巴結(jié)轉(zhuǎn)移比率可以作為獨(dú)立的預(yù)后因素預(yù)測(cè)彌漫型胃癌患者的生存預(yù)后。
[Abstract]:Background & objective: at present, the long-term prognosis after radical gastrectomy is still poor. Therefore, it is very important to determine the relevant indicators to predict the survival of gastric cancer after radical gastrectomy. We investigated the prognostic value of lymph node metastasis ratio and Lauren classification on survival after radical gastrectomy, and analyzed the lymph node metastasis ratio and the corresponding subgroup analysis of Lauren classification. The influence of the number of dissected lymph nodes on the prognosis was studied. The accuracy of lymph node metastasis ratio and lymph node staging in evaluating prognosis was compared. The relationship between lymph node metastasis ratio and Lauren classification was analyzed. The lymph node metastasis ratio was used as a prognostic index to further explore the subgroups of Lauren classification. Methods: the clinical data of 261 patients with gastric cancer after radical gastrectomy were analyzed retrospectively. The survival of the patients included in the standard was analyzed by univariate Kaplan-Meier and multivariate Cox regression. The accuracy of lymph node metastasis ratio (rN) staging and lymph node staging (P N) in predicting the prognosis of patients with gastric cancer after radical gastrectomy was investigated by using the operating characteristic curve (ROC curve). The 1 year, 3 year and 5 year survival rates of lymph node metastasis were analyzed by life table method. The relationship between lymph node metastasis ratio and Lauren classification was analyzed by chi-square test. Survival curve and proportional risk regression (Cox) analysis were used to explore the prognostic value of lymph node metastasis ratio among subgroups of Lauren classification. Results: univariate analysis showed that significant prognostic factors included: maximum diameter of tumor (P0.001), lymph node metastasis ratio (P0.001 / Lauren classification), lymph node staging (P 0.001) and TNM staging (P 0.001). Multivariate analysis showed that the maximum diameter of the tumor was 0.03%, and the lymph node metastasis ratio. P0.001 Lauren classification was an independent predictor of survival after radical gastrectomy. Survival analysis also showed that the higher the lymph node metastasis ratio, the worse the prognosis. In Lauren classification, the prognosis of diffuse type was the worst. ROC curve analysis confirmed that lymph node metastasis ratio staging was more accurate than lymph node staging in predicting survival of gastric cancer after operation. Chi-square test showed that there was no correlation between lymph node metastasis ratio and Lauren classification. Lymph node metastasis ratio and Lauren classification are independent predictors of gastric cancer after radical operation. The subgroup analysis of Lauren's classification indicates that lymph node metastasis ratio can be used as an independent prognostic index to predict the survival of diffuse type patients in Lauren classification. Conclusion: lymph node metastasis ratio and Lauren classification are independent prognostic factors for survival of patients with gastric cancer after radical resection. Lymph node metastasis staging was superior to lymph node staging in predicting prognosis of patients with gastric cancer after radical resection. Lymph node metastasis ratio can be used as an independent prognostic factor to predict the survival and prognosis of patients with diffuse gastric cancer.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 Felix Berlth;Elfriede Bollschweiler;Uta Drebber;Arnulf H Hoelscher;Stefan Moenig;;Pathohistological classification systems in gastric cancer:Diagnostic relevance and prognostic value[J];World Journal of Gastroenterology;2014年19期

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本文編號(hào)：1822834