發(fā)布時(shí)間：2018-03-20 15:47

  本文選題：肝門膽管癌　切入點(diǎn)：梅奧分期　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究梅奧分期中分層因素在HCCA患者預(yù)后中的作用,評(píng)價(jià)梅奧分期對(duì)預(yù)后的預(yù)測(cè)價(jià)值。梅奧分期和AJCC的TNM分期系統(tǒng)(第七版)對(duì)肝門膽管癌患者生存期的預(yù)測(cè)價(jià)值進(jìn)行對(duì)比研究。方法:收集青島大學(xué)附屬醫(yī)院在2004-02-01至2013-01-01期間治療的可進(jìn)行梅奧分期的335例肝門膽管癌患者的臨床資料。所有病例隨訪至2016年9月30日。根據(jù)患者的各種臨床資料,通過入選標(biāo)準(zhǔn),對(duì)收入本研究的病例進(jìn)行核對(duì),符合排除標(biāo)準(zhǔn)的予以排除,最終確認(rèn)研究對(duì)象。根據(jù)基線資料的定義,收集需要的臨床數(shù)據(jù)。用于梅奧分期的資料主要通過影像學(xué)資料獲得,而TNM分期的資料主要是根據(jù)手術(shù)病理結(jié)果獲得。采用Kaplan-Meier生存曲線和log-rank檢驗(yàn)的方法對(duì)各個(gè)指標(biāo)進(jìn)行單因素分析,得到有統(tǒng)計(jì)學(xué)意義的影響因素。然后將上述影響因素導(dǎo)入Cox回歸分析,建立Cox風(fēng)險(xiǎn)比例模型,得到有統(tǒng)計(jì)學(xué)意義的與預(yù)后有關(guān)的獨(dú)立因素。使用Kaplan-Meier生存曲線和log-rank檢驗(yàn)分別對(duì)兩種分期系統(tǒng)與生存期的關(guān)系進(jìn)行相關(guān)性分析,并進(jìn)行系統(tǒng)內(nèi)部的兩兩對(duì)比,評(píng)估分期系統(tǒng)內(nèi)部的區(qū)分度和整體的單一趨勢(shì)。使用ROC曲線對(duì)兩種分期系統(tǒng)進(jìn)行單一趨勢(shì)性分析,通過其面積,比較其在HCCA患者預(yù)后中的評(píng)估能力。結(jié)果:至2016年9月30日,共283例患者死亡,40例無(wú)隨訪資料或拒絕參加此研究,12例患者刪失,刪失比例4.1%。中位生存期為12.4個(gè)月,1年、2年、3年生存率分別為(51.9±2.9)%,(21.1±2.5)%、(12.6±1.9)%。單因素分析中,認(rèn)為腫瘤最大直徑3cm(P0.001)、白蛋白≥35g/L(P0.001)、腫瘤轉(zhuǎn)移(P0.001)、淋巴結(jié)轉(zhuǎn)移(P0.001)、治療方式(P0.001)、前白蛋白≥200g/L(P=0.015)、ECOG評(píng)分(P0.001)、Bismuth-Corlete分型(P0.001)、CA19-9≥1000U/ml(P=0.003)、血管受累(P=0.037)對(duì)HCCA的預(yù)后有影響。通過COX回歸分析,發(fā)現(xiàn)腫瘤最大直徑3cm(P=0.046)、Bismuth-Corlete分型(P0.001)、腫瘤轉(zhuǎn)移(P=0.004)、治療方式(P0.001)、白蛋白≥35g/L(P0.001)、ECOG評(píng)分(0.001)為預(yù)后的獨(dú)立危險(xiǎn)因素。根據(jù)Kaplan-Meier生存曲線變化和log-rank檢驗(yàn)結(jié)果,顯示兩種分期系統(tǒng)均和患者生存期相關(guān)(P0.001),分期級(jí)別越晚,預(yù)后情況越差。通過分期內(nèi)部的兩兩對(duì)比,發(fā)現(xiàn)梅奧分期內(nèi)部各分期之間異質(zhì)性很好,優(yōu)于TNM分期。對(duì)兩種系統(tǒng)的預(yù)后評(píng)估能力進(jìn)行單一趨勢(shì)性分析,發(fā)現(xiàn)梅奧分期ROC曲線下的面積最大(AUC=0.587),優(yōu)于TNM分期(AUC=0.501)。結(jié)論:基于單中心小樣本研究,梅奧分期可用于術(shù)前患者預(yù)后評(píng)估,預(yù)測(cè)價(jià)值優(yōu)于TNM分期,可以提供較好的分層能力。梅奧分期中的腫瘤轉(zhuǎn)移、腫瘤最大直徑3cm和ECOG評(píng)分是影響預(yù)后的獨(dú)立因素,而CA19-9≥1000U/ml是否可以作為3期的評(píng)估指標(biāo),需要進(jìn)一步的研究。根治性手術(shù)切除和提高患者術(shù)前白蛋白水平,可明顯提高患者預(yù)后的生存期。
[Abstract]:Objective: to study the role of stratified factors in Mayo staging in the prognosis of HCCA patients. To evaluate the prognostic value of Mayo staging and AJCC TNM staging system (version 7th) in predicting the survival of patients with hilar cholangiocarcinoma. Clinical data of 335 patients with hilar cholangiocarcinoma treated for Mayo staging up to 2013-01-01. All cases were followed up until September 30th 2016. Through the inclusion criteria, the cases included in this study were checked, excluded according to the exclusion criteria, and the study object was finally confirmed. According to the definition of baseline data, Collect the necessary clinical data. The data used for Mayo's staging are obtained primarily through imaging data, The data of TNM staging were obtained mainly according to the results of operation and pathology. Kaplan-Meier survival curve and log-rank test were used to analyze the single factor of each index. The influencing factors were obtained, and the Cox risk ratio model was established by introducing the above factors into the Cox regression analysis. Kaplan-Meier survival curve and log-rank test were used to analyze the relationship between the two staging systems and survival time respectively, and the internal comparison was made. To evaluate the degree of differentiation within the staging system and the overall single trend. The ROC curve was used to analyze the single trend of the two staging systems, and their area was used to compare their ability to evaluate the prognosis of patients with HCCA. Results: by September 30th 2016, The median survival time was 12.4 months, 1 year, 2 years and 3 years survival rates were 51.9 鹵2.9%, 21.1 鹵2.5% and 12.6 鹵1.9%, respectively. It is considered that the maximum diameter of tumor is 3cm / L P0.001U, albumin 鈮，

本文編號(hào)：1639752