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胰腺癌患者术后复发危险因素研究
发布时间:2019-03-23

第六篇临床医学硕士香港六合资料标题:胰腺癌患者术后复发危险因素研究

  本篇文章目录导航:

  【题目】胰腺癌患者术后复发危险因素研究
  【第一章-第二章】63名胰头部导管腺癌患者复发资料与方法
  【第三章】胰十二指肠切除术后癌症复发研究结果
  【第四章-第五章】胰腺癌手术治疗复发六合图库因素讨论与结论
  【综述-参考文献】胰腺癌的综合治疗

中文摘要

  胰头癌胰十二指肠切除术后复发危险因素六合开奖直播目的:

  通过对吉林大学第一医院 4 年间收治的胰头部导管腺癌行胰十二指肠切除术(pancreaticoduodenectomy,PD)患者的临床资料进行总结,六合开奖直播胰头癌行 PD 手术切除后与患者肿瘤复发和预后的相关危险因素,六合资料预测患者术后生存期的因素,更好的指导临床诊治。

  方法:

  回顾性六合开奖直播我院 2013 年 1 月至 2016 年 12 月收治的 63 例胰头部导管腺癌行胰十二指肠切除术(PD)患者的临床资料,包括一般资料(年龄、性别等)、术前血清学检查、术后病理结果及术后是否行放化疗等。观察指标:(1)患者术前检查结果: 血清总胆红素、白蛋白值、肿瘤标志物(主要包括 CA19-9、CA125、CEA)等。 (2)手术资料: 术中出血量、术后并发症(胰瘘、胆瘘、胃排空延迟、腹腔感染、出血等)。(3)病理学检查结果:肿瘤分化程度、淋巴结转移、血管侵犯。

  (4)患者随访结果:肿瘤复发情况、术后生存情况。采用随访门诊、电话方式随访。术后 1 年内每 3 个月随访 1 次,1 年之后每 6 个月随访一次,随访以肿瘤出现复发或患者死亡为事件终点。随访内容包括病史采集、体格检查、实验室检查(包括 CA19-9、CA125、CEA、肝功能、血常规等)及影像学检查(腹部超声、腹部 CT 或 MRI 等)。若怀疑有复发转移可提前行该检查。复发的诊断主要依据影像学检查结果、肿瘤标志物和临床表现。数据使用 Excel 2007 进行整理,采用SPSS 22.0 软件进行统计六合开奖直播,计数资料采用频数或率表示,早期复发危险因素六合开奖直播中单因素采用卡方检验,多因素六合开奖直播采用二元非条件Logistic 回归;术后无复发生存六合开奖直播中单因素和多因素六合开奖直播均采用COX 比例回归;生存曲线绘制采用 Kaplan-Meier 法;以 p<0.05 判定为有统计学意义。

  结果:

  本研究共随访了63名胰头部导管腺癌患者,最长随访时间为38.0个月,中位随访时间为 11.0 个月,随访过程中共有 3 名患者失访,失访率为 4.76%,随访中一年内共有 37 名患者发生复发,一年内复发率为 58.73%,整个随访中共有 53 名患者发生复发,复发率为84.13%。术后无复发中位生存时间为 11.00(9.47~12.53)个月。术后1 年、2 年、3 年无复发生存率分别为 41.27%、20.11%和 8.94%。

胰腺癌患者术后复发危险因素研究

  根据患者术后一年内是否发生复发将所有患者分为早期复发组和非早期复发组。单因素六合开奖直播结果显示年龄、CA19-9、CA125、CEA、白蛋白、脉管转移、淋巴结转移、肿瘤分化程度和术后化疗是六合图库术后早期复发的危险因素。采用多因素 Logistic 回归六合开奖直播上述因素,结果显示 CA125、脉管转移、淋巴结转移、肿瘤分化程度以及术后是否行化疗是六合图库术后早期复发的独立危险因素。

  将患者一般资料、术前实验室检查资料、术中资料、术后病理学检查结果及术后是否行化疗进行单因素六合开奖直播,结果显示年龄、CA19-9、CA125、CEA、白蛋白、脉管转移、淋巴结转移、肿瘤分化程度和术后是否行化疗是胰头部导管腺癌患者 PD术后无复发生存的六合图库因素,(p<0.05)。然后将这些因素使用 COX 比例风险回归模型进行六合开奖直播,结果提示年龄、CA19-9、白蛋白、脉管转移、肿瘤分化程度、术后是否行化学治疗与无复发生存率有关,可被认为独立危险因素。

  结论:

  1. CA125、脉管转移、淋巴结转移、肿瘤分化程度和术后化疗为六合图库术后早期复发的独立危险因素。

  2. 年龄、CA19-9、白蛋白、脉管转移、肿瘤分化程度、术后化疗是六合图库术后无复发生存率的独立危险因素。

  关键词:胰腺癌,胰十二指肠切除术,复发,治疗,预后

Abstract

  Objective:

  Through the first hospital of jilin university four years of pancreatic ductal adenocarcinoma of the head of pancreaticoduodenal resection (pancreaticoduodenectomy, PD) summarized the clinical data of patients, analysis line PD after surgical removal of the pancreatic head carcinoma associated with tumor recurrence and prognosis of patients with risk factors, factors on patients with predicted postoperative survival and better guide the clinical diagnosis and treatment.

  Method:

  Retrospective analysis in January 2013 to December 2016, 63 cases of pancreatic ductal adenocarcinoma of the head of pancreaticoduodenal resection (PD) in patients with clinical data, including general information (age, gender, etc.), preoperative, postoperative pathologic results and serologic testing whether postoperative radiation and chemotherapy, etc. Observation indexes :(1) preoperative examination results: serum total bilirubin, albumin value, tumor markers (mainly CA19-9, CA125, CEA, etc). (2) surgical data: intraoperative hemorrhage, postoperative complications (pancreatic fistula, biliary fistula, delayed gastric emptying, abdominal infection, bleeding, etc.). (3) pathological examination results: tumor differentiation degree, lymph node metastasis, and vascular invasion. (4) follow-up results: tumor recurrence and postoperative survival. Follow-up outpatient and telephone follow-up were conducted. The follow-up was performed every 3 months for 1 year, followed by 1 year after 1 year, followed by a recurrence of tumor or death of the patient. Follow-up included medical history, physical examination, laboratory examination (including CA19-9, CA125, CEA, liver function, blood routine, etc.) and imaging examination (abdominal ultrasound, abdominal CT or MRI, etc.). If a recurrence is suspected, it can be checked in advance. The diagnosis of recurrence was mainly based on imaging findings, tumor markers and clinical manifestations. Data using Excel 2007, adopting SPSS 22.0 statistical analysis software, count data using frequency or rate, said early recurrence risk factors analysis of single factor using chi-square, multi-factor analysis using binary unconditioned Logistic regression; COX proportional regression was used in the analysis of single factor and multifactor in postoperative survival analysis. The survival curve was plotted using kaplan-meier method; p <0.05 was considered as statistically significant.

  Result:

  This study followed 63 patients with pancreatic ductal adenocarcinoma of the head, the longest follow-up time was 38.0 months and the median follow-up time of 11.0 months, there're a total of 3 patients lost to follow-up process, lost to follow-up rate was 4.76%, followed up a year a total of 37 cases of recurrence, the recurrence rate of 58.73% a year, the follow-up of the communist party of China a 53 patients had a relapse, the recurrence rate was 84.13%. The postoperative survival time was 11.00 (9.47~12.53). The recurrence rate was 41.27%, 20.11% and 8.94%, respectively, 1 year, 2 years and 3 years after surgery.

  All patients were divided into early relapse group and non - early recurrence group according to whether recurrence occurred within one year after surgery. The results of single factor analysis showed that age, CA19-9, CA125, CEA, albumin, vascularization, lymph node metastasis, tumor differentiation and postoperative chemotherapy were the risk factors for early postoperative recurrence. Multiariable Logistic regression analysis to the above factors, the results showed that CA125, vascular metastasis, lymph node metastasis, tumor differentiation degree and postoperative chemotherapy are independent risk factors for early postoperative recurrence.

  The patients' general information, preoperative laboratory data, intraoperative and postoperative pathology, check whether the results and postoperative chemotherapy for single factor analysis, the results showed that age, CA19-9, CA125, CEA, albumin, vascular metastasis, lymph node metastasis, tumor differentiation degree and postoperative chemotherapy was pancreatic ductal adenocarcinoma of the head the influence factors of postoperative relapse-free survival in patients with PD, (p< 0.05). Then these factors using COX proportional hazards regression model is analyzed, the results suggest age, CA19-9, albumin, vascular metastasis, tumor differentiation degree, whether postoperative chemotherapy associated with relapse-free survival rate, can be considered independent risk factors.

  Conclusion:

  1. CA125, vascular metastasis, lymph node metastasis, tumor differentiation and postoperative chemotherapy are independent risk factors for early postoperative recurrence.

  2. Age, CA19-9, albumin, vascular metastasis, degree of tumor differentiation, and postoperative chemotherapy are independent risk factors influencing postoperative survival without recurrence.

  Keywords:Pancreatic cancer, pancreaticoduodenectomy, recurrence, treatment,prognosis.

目 录

  第 1 章 前言
  第 2 章 资料与方法
    2.1 研究对象
    2.2 一般资料
    2.3 统计学方法
  第 3 章 结果
    3.1 研究对象一般情况
    3.2 研究对象术后随访的复发情况
    3.3 术后早期复发危险因素六合开奖直播
      3.3.1 术后早期复发危险因素的单因素六合开奖直播
      3.3.2 术后早期复发危险因素的多因素六合开奖直播
    3.4 胰头癌胰十二指肠切除术后六合图库无复发生存的危险因素六合开奖直播
      3.4.1 六合图库胰头癌 PD 术后无复发生存的危险因素单因素六合开奖直播
      3.4.2 六合图库胰头癌 PD 术后无复发生存的危险因素多因素六合开奖直播
  第 4 章 讨论
    4.1 血清肿瘤标志物检测的意义
    4.2 病理因素对胰头癌术后早期复发及无复发生存的意义
    4.3 术后化疗对胰头癌早期复发及无复发生存的意义
    4.4 年龄、白蛋白值对胰头癌术后无复发生存率的意义
  第 5 章 结论
  综 述
  参考文献
  攻读硕士期间撰写及发表的香港六合资料
  作者简介
  致 谢

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