發(fā)布時(shí)間：2018-08-28 06:29

【摘要】：目的:通過對(duì)1996年1月至2015年12月20年間吉林大學(xué)第二醫(yī)院收治的365例宮頸腺癌患者的臨床病理特點(diǎn)、術(shù)前診斷、治療方案的選擇以及影響預(yù)后的相關(guān)因素進(jìn)行回顧性分析,旨在為選擇合理的治療方案提供依據(jù)。方法:用EXCEL表格對(duì)病例資料進(jìn)行初步統(tǒng)計(jì),對(duì)宮頸腺癌患者的年齡、期別、病理分型、就診主訴、術(shù)前檢查、治療方案、病理結(jié)果、生存情況等因素進(jìn)行初步統(tǒng)計(jì)。應(yīng)用SPSS 19.0系統(tǒng)對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,生存情況采用Kaplan-Meier生存分析法、Log-rank檢驗(yàn)及COX風(fēng)險(xiǎn)比例模型進(jìn)行生存及預(yù)后影響因素分析,并繪制生存曲線。取α=0.05,p0.05認(rèn)為有顯著性的差異。結(jié)果:宮頸腺癌發(fā)病年齡主要集中在46-50歲,不同年代之間發(fā)病年齡差異無統(tǒng)計(jì)學(xué)意義(p0.05),未見明顯年輕化趨勢(shì)。術(shù)前TCT檢出率約為65.6%,HPV-DNA檢出率約為64.4%,而TCT聯(lián)合HPV-DNA檢測(cè)的陽(yáng)性率可高達(dá)85.11%。宮頸腺癌患者總體3年生存率、5年生存率分別為90.8%、65.5%,平均生存時(shí)間為118.858±7.122月,總體3年無進(jìn)展生存期、5年無進(jìn)展生存期分別為83.4%、47.7%,平均無進(jìn)展生存期為87.905±6.308月。Ⅰ期、ⅡA期、ⅡB期、Ⅲ期及以上分期患者5年生存率分別為88.0%、58.7%、33.8%、25%,不同期別生存率差異有顯著性(p0.05)。其生存期和復(fù)發(fā)的主要影響因素包括病理類型、肌層浸潤(rùn)深度、脈管內(nèi)是否有癌栓浸潤(rùn)、淋巴結(jié)轉(zhuǎn)移及卵巢轉(zhuǎn)移情況,其中特殊病理類型、肌層浸潤(rùn)深度≥1/2、脈管內(nèi)有癌栓浸潤(rùn)、有淋巴結(jié)轉(zhuǎn)移及卵巢轉(zhuǎn)移的患者預(yù)后較差(p0.05),5年生存率和5年無進(jìn)展生存率低。年齡、是否保留卵巢對(duì)宮頸腺癌的預(yù)后無明顯影響(p0.05)。是否行術(shù)前新輔助化療對(duì)生存期影響無明顯區(qū)別,與同期別未行新輔助化療患者相比差異無統(tǒng)計(jì)學(xué)意義(p0.05)。多因素分析結(jié)果顯示只有病理類型、FIGO分期是影響宮頸腺癌預(yù)后的獨(dú)立危險(xiǎn)因素(p0.05)。另將所有手術(shù)患者的相關(guān)影響因素納入多因素分析,結(jié)果顯示:FIGO分期、術(shù)后是否接受輔助性治療和卵巢轉(zhuǎn)移情況是影響宮頸腺癌預(yù)后的獨(dú)立危險(xiǎn)因素(p0.05)。結(jié)論:1、宮頸腺癌發(fā)病的年齡主要集中在46-50歲年齡段,近20年患者發(fā)病年齡未見明顯年輕化趨勢(shì);2、單獨(dú)行TCT或HPV檢測(cè)對(duì)宮頸腺癌的診斷陽(yáng)性率比較低,但是兩者聯(lián)合使用可有效提高宮頸腺癌的檢出率;3、對(duì)于早期年輕的女性患者可考慮保留其卵巢,以減輕激素缺乏癥狀;4、ⅠB2-ⅡA2期宮頸腺癌患者術(shù)前應(yīng)用新輔助化療組與同期別直接手術(shù)組相比,生存期及無進(jìn)展生存期沒有明顯差異,但NACT可以在術(shù)前縮小病灶體積、減輕宮旁浸潤(rùn),從而降低手術(shù)難度、同時(shí)減少術(shù)后放化療劑量;5、應(yīng)加強(qiáng)對(duì)有高危因素的宮頸腺癌患者的管理,如特殊類型的宮頸腺癌、肌層浸潤(rùn)深度≥1/2、脈管內(nèi)有癌栓浸潤(rùn)、有淋巴結(jié)轉(zhuǎn)移及卵巢轉(zhuǎn)移等情況,制定具體的個(gè)體化治療,改善生存質(zhì)量,延長(zhǎng)生存期。
[Abstract]:Objective: to analyze retrospectively 365 patients with cervical adenocarcinoma admitted from January 1996 to December 2015 in the second Hospital of Jilin University. The aim is to provide the basis for choosing reasonable treatment plan. Methods: the data of patients with cervical adenocarcinoma were analyzed with EXCEL table. The factors such as age, stage, pathological type, main complaint, preoperative examination, treatment plan, pathological results and survival were analyzed. The data were analyzed by SPSS 19.0 system. The survival conditions were analyzed by Kaplan-Meier survival analysis method and COX risk ratio model, and the survival curve was drawn. The results showed that there was a significant difference between 偽 -0. 05 and 偽-0. 05% (p 0. 05). Results: the onset age of cervical adenocarcinoma was mainly 46-50 years old. There was no significant difference in age between different ages (p0.05), and there was no obvious trend of young age. The detection rate of TCT before operation was 65.6% and that of HPV-DNA was 64.4%, while the positive rate of TCT combined with HPV-DNA could be as high as 85.11%. The overall 3-year survival rate and 5-year survival rate of cervical adenocarcinoma patients were 90.8 and 65.5, respectively. The average survival time was 118.858 鹵7.122 months. The overall 3-year progression-free survival period was 83.4%, and the 5-year progression-free survival time was 83.7%. The average progression-free survival time was 87.905 鹵6.308.The average survival time was 鈪，

本文編號(hào)：2208559