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    直腸癌N分期的影響因素研究

    時間:2019-04-04 來源:吉林大學 作者:戚譯天 本文字數:4797字
      中文摘要
      
      目的:
      
      探討影響淋巴結轉移的結外相關危險因素在評價直腸癌淋巴結轉移中的價值。
      
      方法:
      
      收集吉林大學中日聯誼醫院放射線科自2016年1月至2017年12月期間診斷的108例行直腸癌根治術的原發性直腸癌患者。所有患者均在術前行電子纖維結腸鏡檢查并且病理確診為直腸癌;術前均行MRI檢查,并在檢查后1星期內在全直腸系膜切除術原則下行直腸癌根治術并在術后進行病理學檢查。收集的影像學及病理學資料包括:腫瘤的N分期、腫瘤的位置、腫瘤大小、腫瘤浸潤深度、腫瘤分化程度、腫瘤環周切緣、脈管內癌栓和神經受累程度。
      
      應用spss22.0對數據進行統計學分析。采用雙變量Spearman等級系數法對可能影響直腸癌N分期的因素進行相關分析,探討逐一因素與N分期之間的相關性。為進一步探討影響直腸癌N分期的重要因素,在已做完各項因素獨立性的基礎之上(選取分析結果中P<0.05的變量),采用多項Logistic回歸分析,將N分期(細分為N0、N1a、N1b、N1c、N2a、N2b)設置為因變量,腫瘤的環周切緣、腫瘤的分化程度、脈管內癌栓、神經累及程度設置為變量,進行多項Logistic回歸分析,探討這些因素與直腸癌N分期(細分)之間的關系;采用多項Logistic回歸分析,將N分期(粗分為N0、N1、N2)設置為因變量,腫瘤的分化程度、環周切緣、脈管內癌栓、神經累及程度設置為變量,進行多項Logistic回歸分析,探討這些因素與直腸癌N分期(粗分)之間的關系;采用二元Logistic回歸分析,將N分期(N0、N1a、N1b、N1c捏合為N01,N2a、N2b捏合為N2)設置為因變量,腫瘤的環周切緣、腫瘤的分化程度、脈管內癌栓、神經累及程度設置為變量,進行二元Logistic回歸分析,探討這些因素與直腸癌N分期(二值)之間的關系。

    直腸癌N分期的影響因素研究
      
      結果:
      
      1、腫瘤位置和腫瘤的大小與直腸癌N分期沒有相關性,差異無統計學意義(P>0.05)。腫瘤浸潤深度與直腸癌N分期有顯著正相關(Sig=0.013<0.05,P=0.220);腫瘤分化程度與直腸癌N分期有顯著負相關(Sig=0.000<0.01,P=-0.396)、腫瘤環周切緣與直腸癌N分期有顯著正相關(Sig=0.000<0.01,P=0.389)、脈管內癌栓與直腸癌N分期有顯著正相關(Sig=0.000<0.01,P=0.514)、神經受累程度與直腸癌N分期有顯著正相關(Sig=0.001<0.01,P=0.396)。
      
      2、在多項Logistic回歸分析中,影響直腸癌N分期(細分)的重要因素是脈管內癌栓和環周切緣,但N1a、N1b、N1c、N2a在這個回歸模型下,不能很好的得到概率預測。調整模型后可看出,在影響直腸癌N分期(粗分)的多項Logistic回歸分析中,影響直腸癌N分期的重要因素依然是脈管內癌栓和環周切緣。二元Logistic回歸分析模型中,可以通過脈管內癌栓、神經累及、環周切緣,對N分期的概率進行預測(判斷為N0、1分期,還是N2分期)。其中脈管內癌栓與環周切緣依然是影響N分期的重要因素。
      
      結論:
      
      1、腫瘤的浸潤深度、腫瘤分化程度、環周切緣、脈管內癌栓與神經累及情況是直腸癌淋巴結轉移的結外相關危險因素;腫瘤的位置、腫瘤的大小與直腸癌淋巴結轉移無關。
      
      2、脈管內癌栓和環周切緣在三個不同的 N 分期模型中均有顯著的影響性和相關性。
      
      關鍵詞: 直腸癌,淋巴結轉移,N分期,脈管內癌栓,環周切緣。
      
      Abstract
      
      Object:
      
      To evaluate the value of extranodal risk factors for lymph nodemetastasis in rectal carcinoma.
      
      Materials and Methods:
      
      108 patients with primary rectal cancer had been hospitalizedin the radiology department of China-Japan Union Hospital of JilinUniversity from January 2016 to December 2017 were included inthe study. All patients received electronic fibro-colonoscopeexamination before operation and were diagnosed as rectalcarcinoma. All patients received surgery treatment in one weekafter MRI examination and the tumor specimen receivedpostoperative pathological examination. Radical resection ofrectal carcinoma was under the principle of total mesorectalexcision. The collection data of imaging and pathology include theN stage, the location and size of the tumor, invasion depth of tumor,degree of differentiation, circumferential resection margin,intravascular tumor thrombus and nerve involvement.
      
      The data were statistically analyzed with spss22.0. Twovariables Spearman rank coefficient method was used to analyzethe factors that may influence the N staging of rectal cancer, and toexplore the correlation between one by one factor and N stage. To further explore the factors that affecting the N staging of rectalcancer, on the basis of the independence of various factors(selecting the variables of P<0.05 in the analysis results), multiplelogistic regression analysis was used to set the N staging(subdivided into N0, N1a, N1b, N1c, N2a, N2b) to be variable, anddegree of differentiation, circumferential resection margin,intravascular tumor thrombus and nerve involvement were set asvariables. Multiple logistic regression analysis was conducted toexplore the relationship between these factors and N staging(subdivision) of rectal cancer. Using multiple logistic regressionanalysis to set the N staging (as N0, N1, N2) to be variable, anddegree of differentiation, circumferential resection margin,intravascular tumor thrombus and nerve involvement were set asvariables. Multiple Logistic regression analysis was conducted toexplore the relationship between these factors and N staging(rough division) of rectal cancer. Using binary logistic regressionanalysis, N staging (N0, N1a, N1b, N1c were merged into N01, N2a,N2b merged into N2) to be variable, and degree of differentiation,circumferential resection margin, intravascular tumor thrombus andnerve involvement were set as variables. Binary logistic regressionanalysis was conducted to explore the relationship between thesefactors and N staging (two value) of rectal cancer.Results:
      
      1. Both the location and size of the tumor are not related to Nstage of rectal cancer, there are no statistic difference betweenthem(P>0.05). There is a significant positive correlation betweeninvasion depth of tumor and N stage of rectal cancer(sig=0.013<0.05,P=0.220); degree of differentiation is significantlynegative correlated with N stage of rectal cancer (Sig=0.000<0.01,P=-0.396); circumferential resection margin is significantly positivecorrelated with N stage of rectal cancer(Sig=0.000<0.01,P=0.389);intravascular tumor thrombus is significantly positive correlated withN stage of rectal cancer (Sig=0.000<0.01,P=0.514), and nerveinvolvement is significantly positive correlated with N stage of rectalcancer (Sig=0.001<0.01,P=0.396).
      
      2. In multiple logistic regression analysis, the important factorsthat affect the N staging (subdivision) of rectal cancer areintravascular tumor thrombus and circumferential resection margin,but N1a, N1b, N1c and N2a can not be well predicted by thisregression model. After adjusting the model, we can see that in themultiple logistic regression analysis that affects the N staging(roughdivision) of rectal cancer, the important factors that affect the Nstaging of rectal cancer are still intravascular tumor thrombus and circumferential resection margin. In the binary logistic regressionanalysis model, the probability of N staging can be predicted by theintravascular tumor thrombus, nerve involvement andcircumferential resection margin (judging as N0, N1 or N2 staging).
      
      Among them, intravascular tumor thrombus and ccircumferentialresection margin are still important factors affecting N staging.
      
      Conclusions:
      
      1.Invasion depth of tumor, degree of differentiation,circumferential resection margin, intravascular tumor thrombus andnerve involvement are associated with lymph node metastasis ofrectal carcinoma.
      
      2.Intravascular tumor thrombus and circumferential resectionmargin have significant influence an correlation in three differentN-staging models.
      
      Keywords: Rectal carcinoma , Lymph node metastasis , N stage ,Intravascular tumor thrombus,Circumferential resection margin。
      
      第 1 章 前言
      
      直腸癌(Rectal Carcinoma)是最常見的消化系統惡性腫瘤之一[1],約占結直腸癌的 50%-70%[2],占全身惡性腫瘤的 15%[3],并且其發病率有逐年上升的趨勢,嚴重威脅著人們的健康。在我國,直腸癌的發病率和死亡率位居第五位[4];在歐美等西方國家,其發病率及死亡率居第二位[5]。目前,對于直腸癌的發病原因尚未完全明確,但普遍認為其可能與高動物脂肪及動物蛋白的飲食習慣、遺傳易感性因素、環境變化及精神因素有關。
      
      直腸癌的治療方法在近年來取得了較大進展,全直腸系膜切除術及新輔助放化療的使用,降低了局部復發率,延長了患者生存率。MRI是目前常用并且有效的檢查方法,結直腸鏡和病理學檢查是確診直腸癌的“金標準”。淋巴結轉移是直腸癌局部復發的重要危險因素[6]。既往關于直腸癌轉移淋巴結的評估更關注淋巴結自身,如淋巴結的直徑大小、短長徑比、邊緣、密度、信號以及數目等方面,但其診斷淋巴結轉移的準確度均不理想。目前對除淋巴結本身以外的因素報道有限,并且研究結果大部分是小樣本量的病例資料,釆用單因素分析的統計學方法,并不能排除各因素間的相互作用的影響,也未能找出影響直腸癌淋巴結轉移最主要的因素。因此,本文擬探討直腸癌淋巴結的結外因素,如腫瘤生長位置、腫瘤大小、腫瘤浸潤深度、腫瘤分化程度、脈管內癌栓及神經累及等在評價直腸癌淋巴結轉移中的價值,旨在提高直腸癌區域淋巴結良惡性的診斷效價。
    【由于本篇文章為碩士論文,如需全文請點擊底部下載全文鏈接】
      
      第 2 章 研究對象和方法
      

      2.1 病例資料
      2.2 檢查方法
      2.3 判斷標準
      2.4 圖像分析
      2.5 病理檢查
      2.6 數據處理
      2.6.1 收集的數據包括
      2.6.2 分類變量的分組
      2.6.3 本文涉及的統計學方法
      
      第 3 章 結果
      

      3.1 病例數據的簡單數據統計
      3.2 直腸癌的 N 分期與各項變量的雙變量 Spearman 等級系數法相關分析結果
      3.2.1 腫瘤位置(腫瘤下緣距肛緣距離)與直腸癌 N 分期的關系
      3.2.2 腫瘤大小(病變長度)與直腸癌 N 分期的關系
      3.2.3 腫瘤浸潤深度(直腸癌 T 分期)與直腸癌 N 分期的關系
      3.2.4 腫瘤的分化程度與直腸癌 N 分期的關系
      3.2.5 腫瘤的環周切緣與直腸癌 N 分期的關系
      3.2.6 脈管內癌栓與直腸癌 N 分期的關系
      3.2.7 神經累及程度與直腸癌 N 分期的關系
      3.3 直腸癌 N 分期(細分)的多因素 Logistic 回歸分析結果
      3.4 直腸癌 N 分期(粗分)的多因素 Logistic 回歸分析結果
      3.5 直腸癌 N 分期(二值)的二元 Logistic 回歸分析結果
      
      第 4 章 討論
      
      4.1 腫瘤的位置
      4.2 腫瘤的大小
      4.3 腫瘤浸潤深度
      4.4 腫瘤分化程度
      4.5 環周切緣
      4.6 脈管內癌栓及神經累及程度

      第 5 章 結論

      1、腫瘤的浸潤深度、腫瘤分化程度、環周切緣、脈管內癌栓與神經累及情況是直腸癌淋巴結轉移的結外相關危險因素;腫瘤的位置、腫瘤的大小與直腸癌淋巴結轉移無關。

      2、脈管內癌栓和環周切緣在三個不同的 N 分期模型中均有顯著的影響性和相關性。
      
      參考文獻

      戚譯天.直腸癌淋巴結轉移的結外相關危險因素分析[D]. 吉林大學 2018
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