本文選題：多學(xué)科 + 結(jié)直腸癌肝轉(zhuǎn)移　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:目前,對(duì)伴有肝轉(zhuǎn)移的結(jié)直腸癌患者,單純進(jìn)行手術(shù)、化療、放療、分子靶向藥物治療、介入治療等均有所獲益。但單一療法已經(jīng)難以獲得滿意的治療效果。多學(xué)科團(tuán)隊(duì)診療模式的出現(xiàn)為解決這一問題做出巨大貢獻(xiàn),關(guān)于其臨床獲益,目前尚無明確報(bào)道。本研究回顧性搜集大連醫(yī)科大學(xué)附屬第一醫(yī)院腫瘤科首診時(shí)新確診的CRCLM患者,對(duì)其臨床資料進(jìn)行分析。旨在評(píng)估MDT診療模式對(duì)CRCLM患者的臨床應(yīng)用價(jià)值。方法:搜集2013年8月至2016年2月期間,大連醫(yī)科大學(xué)附屬第一醫(yī)院腫瘤科收治的,符合以下納入標(biāo)準(zhǔn)的患者:(1)年齡18歲,性別不限;(2)ECOG評(píng)分2;(3)有病理組織學(xué)證據(jù),證實(shí)為CRC;(4)經(jīng)影像學(xué)證實(shí)有肝轉(zhuǎn)移;(6)于腫瘤科門診或住院部首診確診為CRCLM的患者,且既往未進(jìn)行任何腫瘤相關(guān)治療;(6)既往無腫瘤病史;(7)初診時(shí)無肝外轉(zhuǎn)移;(8)既往無嚴(yán)重心臟病史;對(duì)所搜集的患者進(jìn)行全程追蹤隨訪,隨訪截至日期至2017年2月。根據(jù)患者入院后是否參與MDT會(huì)診,將參與會(huì)診的患者納入MDT組,未參與會(huì)診的患者納入非MDT組。應(yīng)用SPSS 20.0統(tǒng)計(jì)軟件,對(duì)所搜集的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。采用卡方檢驗(yàn)對(duì)比兩組一般臨床資料,采用配對(duì)t檢驗(yàn)比較組內(nèi)治療前后生活質(zhì)量差異,應(yīng)用重復(fù)測(cè)量方差分析對(duì)比兩組間生活質(zhì)量差異,使用Kaplan-Meier法對(duì)兩組生存情況進(jìn)行分析。P0.06代表有統(tǒng)計(jì)學(xué)意義。結(jié)果:經(jīng)過篩選,共搜集符合條件的CRCLM患者114例,MDT組納入患者63例(n=63),非MDT組納入患者61例(n=61)。1.一般資料兩組患者基線資料,包括年齡、性別、病理類型、原發(fā)灶情況(部位、侵犯程度、淋巴結(jié)轉(zhuǎn)移)、肝轉(zhuǎn)移情況(部位、數(shù)目、大小)均無差異,P0.0g。2.手術(shù)切除率兩組共有46例患者接受手術(shù)治療,總體手術(shù)切除率39.47%;MDT組共有29例患者施行手術(shù)治療,手術(shù)切除率為64.72%;非MDT組共有16例患者施行手術(shù)治療,手術(shù)切除率為26.23%;兩組患者手術(shù)切除率存在統(tǒng)計(jì)學(xué)差異,P0.06。3.生活質(zhì)量MDT組患者治療后較治療前在軀體功能、情緒功能、總體健康狀況、惡心/嘔吐及疼痛等方面有所改善,P0.06;非MDT組患者治療后較治療前僅在軀體功能、總體健康狀況、惡心/嘔吐及疼痛等方面有所改善,P0.06;MDT組與非MDT組患者在軀體功能、情緒功能、總體健康情況、惡心/嘔吐及疼痛上的改善均有顯著差異,P0.06。4.生存期隨訪結(jié)束時(shí)間為2017年2月。MDT組隨訪4-41個(gè)月,隨訪結(jié)束時(shí)27人死亡,無失訪病例。中位0S,1,2年生存率分別為26.04±1.44個(gè)月,93.66%,66.71%。非MDT隨訪3-40個(gè)月,隨訪結(jié)束時(shí)32人死亡,失訪1人。中位os,1,2年生存率分別為21.12 ±1.39個(gè)月,86.94%,39.34%。兩組1年生存率無差異(X2=2.34,P=0.21),MDT組患者的中位0S和2年生存率顯著高于非MDT組,差異有統(tǒng)計(jì)學(xué)意義(OS X2=6.00,P=0.026,2 年生存率 X2=11.26,P=0.001)結(jié)論:1.MDT診療模式可以提高CRCLM患者的手術(shù)切除率。2.MDT診療模式可以改善CRCLM患者的生活質(zhì)量。3.MDT診療模式能夠延長(zhǎng)CRCLM患者的生存期(中位0S,2年生存率),對(duì)于長(zhǎng)期生存率的影響有待于進(jìn)一步研究。
[Abstract]:Objective: at present, surgery, chemotherapy, radiotherapy, molecular targeted drug therapy and interventional therapy are beneficial for colorectal cancer patients with liver metastases. However, single therapy has been difficult to achieve satisfactory results. The emergence of multidisciplinary team diagnosis and treatment model has made great contributions to solving the problem. This study reviewed the clinical data of the newly diagnosed CRCLM patients at the First Affiliated Hospital of Dalian Medical University, the first hospital of the First Affiliated Hospital of Dalian Medical University. The purpose of this study was to evaluate the clinical application value of the MDT diagnosis and treatment model to the patients of CRCLM. Methods: from August 2013 to February 2016, the First Affiliated Hospital of Dalian Medical University was collected. Patients admitted to the Department of oncology were in accordance with the following criteria: (1) age 18, sex unlimited; (2) ECOG score 2; (3) histopathological evidence, CRC; (4) liver metastases confirmed by imaging; (6) patients diagnosed with CRCLM in the oncology outpatient or inpatient department, without any previous tumor related treatment; (6) without previous oncology (7) no extrahepatic metastases at first diagnosis; (8) no history of serious heart disease; the whole course was followed up and followed up to February 2017. The patients who participated in the MDT consultation were included in the group MDT, and the patients who were not involved in the consultation were included in the non MDT group. The SPSS 20 statistical software was used to search the patients. The data of the set were statistically analyzed. Two groups of general clinical data were compared with the chi square test. The difference of life quality before and after treatment in the group was compared with the paired t test. The difference of life quality between the two groups was compared with the repeated measurement of variance analysis. The statistical significance of the two groups of survival conditions in the two groups was analyzed by the Kaplan-Meier method. Results: after screening, 114 patients with eligible CRCLM were collected, 63 cases (n=63) were included in group MDT, and the baseline data of two groups of patients with 61 cases (n=61).1. were included in the non MDT group, including age, sex, pathological type, primary lesion (location, invasion range, lymph node metastasis), and liver metastasis (location, number, size), P0 There were 46 cases of.0g.2. resection rate in two groups, the total resection rate was 39.47%, and 29 patients in group MDT were treated with surgical resection rate of 64.72%, and 16 patients in non MDT group were treated with surgical resection rate of 26.23%, and there were statistically significant differences in hand resection rate in the two groups, and P0.06.3. quality of life MD. After treatment, the patients in group T were improved in physical function, emotional function, overall health, nausea / vomiting and pain, P0.06. Patients in non MDT group were improved in physical function, overall health status, nausea / vomiting and pain before treatment, P0.06, MDT and non MDT patients in body function and mood. There were significant differences in function, overall health, nausea / vomiting and pain improvement. The P0.06.4. survival period was followed up for 4-41 months in group.MDT in February 2017. At the end of the follow-up, 27 people died, no missing cases. The median 0S, 1,2 year survival rate was 26.04 + 1.44 months respectively, 93.66%, 66.71%. non MDT follow-up 3-40 months, 3 at the end of follow-up 3. 2 people died and lost 1. Median OS, 1,2 year survival rate was 21.12 + 1.39 months respectively, 86.94%, 39.34%. two group 1 year survival rate no difference (X2=2.34, P=0.21). The median 0S and 2 years survival rate in group MDT was significantly higher than that of non MDT group, the difference was statistically significant (OS X2=6.00, P= 0.026,2 year survival rate) conclusion: To improve the surgical excision rate of CRCLM patients.2.MDT diagnosis and treatment model can improve the quality of life of CRCLM patients,.3.MDT diagnosis and treatment model can prolong the survival period of CRCLM patients (median 0S, 2 year survival rate), and the effect on long-term survival needs to be further studied.
【學(xué)位授予單位】：大連醫(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)】：R735.34
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本文編號(hào)：2015584