257例Ⅰ～Ⅱ期子宫内膜癌复发的危险因素分析

目的：探讨Ⅰ～Ⅱ期子宫内膜癌复发的原因及相关危险因素。方法：回顾性收集2013年6月至2018年6月期间,中国医科大学附属盛京医院收治并连续随访的257例Ⅰ～Ⅱ期子宫内膜癌患者资料,包括一般资料、临床病理资料、随访患者的复发情况。采用单因素及多因素回归模型分析Ⅰ～Ⅱ期子宫内膜癌复发的相关危险因素。结果：257例Ⅰ～Ⅱ期子宫内膜癌患者中,41例复发,复发率为16.0％。肿瘤直径、淋巴脉管浸润、病理分级是影响Ⅰ～Ⅱ期子宫内膜癌复发的独立危险因素（P＜0.05）。年龄、高血压、体重指数、手术病理分期、盆腔淋巴结切除术及切除数目不是影响Ⅰ～Ⅱ期子宫内膜癌复发的独立危险因素（P＞0.05）。结论：在临床工作中,需要对肿瘤直径＞2cm、存在淋巴脉管浸润、病理分级较高（G2／G3）的Ⅰ～Ⅱ期子宫内膜癌患者密切随访复查,给予患者及时、足量、足疗程的辅助治疗以降低复发率。     

子宫内膜癌的预后影响因素分析

背景与目的:子宫内膜癌的预后影响因素较多,但其中仅有少数因素对预后构成独立影响。本研究的目的在于探讨子宫内膜癌的独立预后影响因素。方法:对我院1990年1月至2000年12月间初治时行手术治疗的265例子宫内膜癌患者的临床资料进行回顾性研究,预后相关因素采用单因素分析及多因素相关回归分析,并进行逐步筛查。结果:本组病例的5年无瘤生存率及总生存率分别为83.3%和84.3%。单因素分析显示:临床分期、手术-病理分期、病理分级、组织学类型、肌层浸润深度、宫颈受累、淋巴结转移、腹腔液性质、脉管瘤栓及附件转移与5年无瘤生存率及总生存率有显著性相关(P<0.05),年龄、合并症因素与预后无显著性相关(P>0.05)。经多因素分析后得出,手术-病理分期、病理分级、肌层浸润深度及宫颈受累4个因素对子宫内膜癌患者的5年无瘤生存率及总生存率均产生显著性影响(P<0.05),临床分期仅对5年无瘤生存率有显著性影响(P<0.001),而对总生存率无显著性影响(P=0.074)。肌层浸润>50%者远处转移率(12.9%)明显高于≤50%者(0.6%)(P<0.001)。宫颈受累者的淋巴结转移率(21.1%)明显高于宫颈未受累者(3.6%)(P<0.001)。结论:FIGO分期、病理分级、肌层浸润深度及宫颈受累是子宫内膜癌独立的预后影响因素。在估计预后方面,手术-病理分期     

子宫内膜癌组织中GATA结合蛋白3、人附睾蛋白4的表达及临床意义

目的 探讨子宫内膜癌组织中人附睾蛋白4(HE4)、GATA结合蛋白3(GATA3)的表达及临床意义。方法 将32例子宫内膜癌患者设为子宫内膜癌组,33例不典型增生患者设为不典型增生组,27例健康体检者设为正常对照组。统计3组受试者组织中HE4、GATA3阳性表达情况,分析GATA3、HE4阳性表达与子宫内膜癌患者临床特征的关系,计算HE4与GATA3单独及联合检测对子宫内膜癌的诊断效能。结果 子宫内膜癌组患者HE4、GATA3阳性表达率均高于不典型增生组和正常对照组,不典型增生组患者HE4、GATA3阳性表达率均高于正常对照组,差异均有统计学意义(P﹤0.05)。有淋巴结转移、肿瘤直径≥2 cm、组织学分级为G₃级、有脉管浸润、手术-病理分期为Ⅲ+Ⅳ期子宫内膜癌患者子宫内膜癌组织中HE4、GATA3阳性表达率分别高于无淋巴结转移、肿瘤直径﹤2 cm、组织学分级为G₁+G₂级、无脉管浸润、手术-病理分期为Ⅰ+Ⅱ期患者,差异均有统计学意义(P﹤0.05)。有淋巴结转移、肿瘤直径≥2 cm、组织学分级为G₃     

子宫内膜癌盆腔淋巴结转移相关因素分析

目的探讨子宫内膜癌患者盆腔淋巴转移的相关因素及其意义。方法子宫内膜癌247例分为伴有淋巴结转移组及不伴有淋巴结转移组,对两组病例的病理类型、病理分级、肌层浸润、宫颈间质浸润及脉管浸润的关系进行统计学分析。结果 伴有淋巴结转移中高分化者占28.57%,低分化占33.33%;不伴有淋巴结转移组中高分化占49.56%,低分化占12.83%,两组差异有统计学意义（P<0.05）。伴有淋巴结转移组中,无肌层浸润0例,肌层浸润深度<1/2占33.33%,肌层浸润深度≥1/2占66.67%,脉管浸润占47.62%,宫颈浸润占47.62%;不伴有淋巴结转移组中,无肌层浸润占11.5%,肌层浸润深度<1/2占66.81%,肌层浸润深度≥1/2占21.68%,脉管浸润占7.08%,宫颈浸润病例占7.96%,两组差异有统计学意义（P<0.05）。结论脉管浸润、宫颈间质浸润、肌层浸润深度≥1/2及低分化与子宫内膜癌盆腔淋巴结转移有相关性,是子宫内膜癌盆腔淋巴结转移的高危因素。     

子宫内膜癌患者术中淋巴结切除和预后的影响因素分析

目的 分析影响子宫内膜癌患者术中淋巴结切除和预后的因素.方法 收集100例接受初次手术治疗且随访资料完整的子宫内膜癌患者的临床资料.观察不同临床特征的子宫内膜癌患者淋巴结切除情况和预后的差异,分析影响子宫内膜癌患者预后和是否进行淋巴结切除的因素.结果 有腹主动脉旁淋巴结(PALN)转移、国际妇产科联盟(FIGO)分期为Ⅲ～Ⅳ期和淋巴脉管间隙浸润(LVSI)阳性的子宫内膜癌患者手术过程中淋巴结切除率分别明显高于无PALN转移、FIGO分期为Ⅰ～Ⅱ期、LVSI阴性患者,差异均有统计学意义(P﹤0.01).肌层浸润深度≥1/2层、有PALN转移、FIGO分期为Ⅲ～Ⅳ期和LVSI阳性子宫内膜癌患者死亡率分别明显高于肌层浸润深度﹤1/2层、无PALN转移、FIGO分期为Ⅰ～Ⅱ期、LVSI阴性患者,差异均有统计学意义(P﹤0.01).FIGO分期为Ⅲ～Ⅳ期和有PALN转移是子宫内膜癌患者术中进行淋巴结切除和预后的危险因素.结论 FIGO分期及PALN转移会直接影响子宫内膜癌患者术中是否进行淋巴结切除和预后,可作为临床参考的重要指标.     

45岁以下子宫内膜癌患者术后3年生存影响因素分析

目的:分析45岁以下子宫内膜癌患者术后3年生存影响因素。方法:收集2009年1月至2011年12月在唐山市妇幼保健院诊断为子宫内膜癌的患者,均行子宫全切术,术后病理证实为子宫内膜癌患者88例。并根据其年龄将其分为A组（≤35岁）35例,B组（36~45岁）53例,对2组患者的生存影响因素进行单因素及多因素分析。结果:对患者的预后因素中组织学类型、病理分级、肌层浸润深度、淋巴结转移、附件转移、腹腔细胞学、雌孕激素受体等7个因素行单因素分析,结果显示组织学类型、病理分级、肌层浸润深度、淋巴结转移、附件转移、腹腔细胞学对患者的预后有影响（P均<0.05）。雌激素受体阳性患者3年生存率高于雌激素受体阴性患者,有统计学意义（P<0.05）。孕激素受体对患者预后无影响(P>0.05)。45岁以下子宫内膜癌术后放疗、化疗、孕激素治疗三者3年生存比较,无明显差异（P>0.05）。未接受治疗患者3年生存率为57.14%,低于接受放疗、化疗、孕激素治疗患者的3年生存率,均有统计学意义（P<0.05）。多因素回归分析得出肿瘤浸润深度、淋巴结转移是影响预后的独立因素。结论:45岁以下子宫内膜癌患者其发生与雌激素有关,尤其是≤35岁者,高危因素少,预后较好。对于早期45岁以下子宫内膜癌患者可考虑保留生育功能或卵巢。早期发现、早期诊断是提高45岁以下子宫内膜癌患者术后3年生存率的核心,早期手术治疗及术后辅助治疗是提高患者术后3年生存率的保障。     

子宫内膜癌盆腔淋巴转移相关因素分析

目的 探讨子宫内膜癌患者盆腔淋巴结转移的有关临床病理特点。方法 对８３例行子宫切除加双侧附件切除术及盆腔淋 吉清扫要的子宫内膜癌的盆腔淋巴结转移有关临床病理特征进行单因素及多因素分析。结果 脉管受侵、深肌层浸润、肿瘤分化差、病灶弥温型患者盆腔淋巴结转移率高。其中脉管受侵为盆腔淋巴转移独立相关因素。结论 脉管受侵、深肌层浸润、肿瘤分化差、病灶弥漫型是盆腔淋巴结转移高危因素,其中脉管受侵意义最大。有高危因素者建议行盆腔淋巴清扫术。     

绝经前后子宫内膜癌生存因素分析

目的:探讨绝经前后子宫内膜癌的临床资料及预后相关因素。方法:选取2008年1月至2012年3月在唐山市妇幼保健院诊断为子宫内膜腺癌,并接受了手术方法治疗的患者240例。随访共36个月,至2015年3月,分为绝经前和绝经后两组。绝经前115例,绝经后125例,比较两组患者的临床特征、单因素分析两组影响子宫内膜癌患者的预后相关因素及两组间生存率差异。结果:本研究显示绝经前组和绝经后组子宫内膜癌在腺癌类型、深肌层浸润、宫颈受累、淋巴转移、附件受累、病理分级例数、ER、PR阳性例数,比较两者均差异无显著性(P＞0.05)。两组患者的组织类型、浸润深度、病理分级、附件转移、宫颈受累是影响子宫内膜癌预后的独立因素。绝经前与绝经后患者的3年生存率分别为87%、72%,P＜0.05,有明显统计学意义。结论:绝经前后子宫内膜癌预后差异显著,绝经是预后的独立因素。     

子宫内膜癌腹膜后淋巴结转移相关因素及预后临床分析

目的 探讨子宫内膜癌腹膜后淋巴结转移及预后的相关因素.方法 回顾性分析80例行子宫切除术加淋巴结清扫术的子宫内膜癌患者的临床资料,对患者腹膜后淋巴结转移相关因素及预后情况进行单因素及多因素分析.结果 病理分期、病理类型、病理分级、肌层浸润程度、子宫浆膜浸润以及脉管内癌栓是影响腹膜后淋巴结转移的相关因素(P＜0.05),其中病理分期、病理类型、病理分级以及脉管内是否有癌栓是影响患者腹膜后淋巴结转移的独立危险因素(P＜0.05).腹膜后淋巴结转移患者生存状况改善有效率为56.52％,明显低于未转移患者(89.47％),差异有统计学意义(P＜0.05).淋巴结转移组患者1年生存率(69.57％)明显低于无转移组患者(96.49％),差异有统计学意义(P＜0.05).结论 病理分期、病理类型、病理分级以及脉管内癌栓是影响子宫内膜癌腹膜后淋巴结转移的独立危险因素,腹膜后淋巴结转移可对患者生存质量及生存率造成影响.     

术后放射治疗Ⅰ期子宫内膜癌患者预后影响因素的分析

目的探讨放射治疗Ⅰ期子宫内膜癌术后患者的生存状况和预后的影响。方法选取2010年1月至2011年1月间进行术后放疗的164例Ⅰ期子宫内膜癌患者,采用门诊随访的形式对患者随访,对随访结果进行分析。结果 1、2、3、4和5年生存率分别为94.5%、91.5%、87.8%、82.3%和76.8%,中位生存时间为54个月。年龄、放疗前贫血、子宫下段受累和内分泌治疗对患者的生存期有影响(均P<0.05)。年龄、放疗前贫血、子宫下段受累和内分泌治疗是预后的独立影响因素(均P<0.05)。结论Ⅰ期子宫内膜癌患者手术后放射治疗的5年生存率高,年龄、放疗前贫血、子宫下段受累和内分泌治疗是预后的独立影响因素。     

Association of meningioma with reproductive factors

Meningiomas occur more commonly in females. The coincidence between meningioma and breast cancer and case reports of tumor growth during pregnancy support a hormonal hypothesis. A case control study was conducted to investigate this. Female subjects treated between 1987 and 1992 were identified from 3 hospitals in the Chicago area. Female spouses of male back pain patients were recruited as controls. A self-administered mail questionnaire focused on exogenous, endogenous and other hormonal factors, personal and family medical history as well as radiation exposures. Odds ratios and 95% confidence intervals were estimated using crude, stratified and multivariable logistic models including 219 cases and 260 controls. Participation rates were 86% among cases and 75% among controls. An increased odds ratio (OR) was observed comparing African Americans to Caucasians [OR = 2.4, 95% confidence interval (CI) = 1.0-6.1]. A protective effect was observed for pregnancy, which increased with number and age at first pregnancy. The odds ratio for 3 or more pregnancies compared to none was 0.3 (95% CI = 0.2-0.6). Age at menarche or total period of hormonal activity was not protective. Ever smokers showed a decreased odds ratio for meningioma (OR = 0.6, 95% CI = 0.4-0.9). The increased odds ratios with African Americans was retained in post-menopausal women, while the protective odds ratios for pregnancy, smoking and oral contraceptives (OCs) became stronger in pre-menopausal women. The pattern by duration and timing of use does not suggest an etiologic role for OCs or hormone replacement therapy. These data add to the evidence that factors known to influence endogenous hormones (pregnancy and indirectly smoking) may have protective effects for meningiomas primarily in premenopausal women.     

Reproductive factors associated with mastalgia.

Mastalgia has been classified as an aberration of the normal, rather than a disease. We present an age-matched, case-control study which compares the reproductive factors of patients with severe cyclical and noncyclical mastalgia with control groups of women who presented to a breast clinic but in whom no clinical abnormality was found and who did not later develop breast disease. There were few statistically significant differences in reproductive factors between the cases and controls, which lends some support to the concept that mastalgia can be considered to be an aberration of the normal.     

血管生长因子与肝细胞性肝癌的关系

血管生长因子对于肿瘤的血管新生具有重要的作用 ,因此也影响肿瘤的发生、发展、浸润和转移等生物学行为。肝细胞癌 (hepatocellularcarcinoma ,HCC)是富血供的肿瘤 ,血管生长因子对其微血管的生成影响较大。介绍了与HCC有关的血管生长因子 ,并阐述它们的作用机制 ,以及它们对于HCC生物学行为的影响     

影响儿童横纹肌肉瘤预后的危险因素

 目的　分析影响儿童横纹肌肉瘤（RMS）预后的危险因素。方法　对56例RMS病例资料进行回顾性分析。结果　单因素分析显示,肿瘤原发部位、大小、病理类型、临床分期、手术完全切除与否、不同治疗方案与RMS患儿生存时间存在相关性（P＜0.05）;多因素分析显示,临床分期是影响RMS患儿预后的独立危险因素（Wald值为8.762,P＝0.003）。结论　RMS的预后与肿瘤原发部位、肿瘤大小、病理类型、临床分期、手术完全切除与否相关,临床分期是影响RMS患儿预后的独立危险因素,将手术、放疗及化疗结合的综合治疗可提高RMS患儿生存率。     

Evaluation of factors associated with skin self-examination.

Early detection and excision of thin lesions may be important in reducing mortality from melanoma. Periodic skin self-examination may be beneficial in identifying thin lesions. The purpose of this study was to evaluate factors associated with skin self-examination. The study population was comprised of 549 Caucasian residents of Connecticut 18 years of age or older who were selected as controls as part of a population-based case-control study on skin self-examination and melanoma conducted during 1987-1989. Personal interviews were conducted to obtain information on skin self-examination, demographics, history of cancer, phenotypic characteristics, sun exposure habits, and screening and health behaviors. Nevus counts were performed by trained nurse interviewers. Logistic regression was used to model the relationship between the variables of interest and skin self-examination. Female gender was identified a priori as a predictor of skin self-examination, and thus all analyses were stratified by gender. Age, education, and marital status were also identified a priori as important predictor variables and were selected for inclusion in the final models. Skin awareness was a strong factor associated with skin self-examination for both females and males. For females, previous benign biopsy or the presence of an abnormal mole was identified as important for future skin self-examination using our criteria. A family history of cancer, physician examination, and change in diet to reduce cancer risk increased the likelihood of skin self-examination in males but not females. In women, light hair color may increase the likelihood of performing skin self-examination. Older age and college or postgraduate education was associated with a decreased likelihood of performing skin self-examination in both males and females. Identifying factors associated with skin self-examination will enable health care providers to target individuals who may not be performing skin self-examination but who are at increased risk for developing melanoma.     

脑胶质瘤致癫痫发作的危险因素分析

目的:探讨导致胶质瘤患者癫痫发作的多种危险因素,并对这些危险因素进行分析。方法:回顾性分析2006年1月至2008年11月,于我科经手术病理证实为胶质瘤的159例患者的临床资料,根据患者的临床资料,采用SPSS统计软件,对导致癫痫的有统计学差异的筛选变量进行Logistic多元回归分析。结果:肿瘤大小(β=0.547),瘤周水肿带大小(β=1.166),肿瘤病理级别(β=-0.803)是导致癫痫发作的具有统计学意义的因素,其优势比(OR)分别为1.729、3.210、0.448。结论:肿瘤大小,瘤周水肿带大小,肿瘤病理级别是导致癫痫发作的重要因素。     

Prognostic factors in children with Ewing''s sarcoma

Patient characteristics of 272 patients entered in a clinical trial conducted by the Pediatric Intergroup Ewing's Sarcoma Committee between June 1972 and November 1978 were examined for their relationship to prognosis. Prognosis was defined as disease-free survival time (time to local recurrence and/or metastatic disease) and overall survival time; all times were measured from the start of treatment. In a multivariate regression model, primary site of disease was the major variable that influenced prognosis, and patients with pelvic sites had the least favorable prognoses, followed by those with proximal and rib sites. The most favorable sites were distal and other. The median disease-free and survival times in weeks by primary site were, respectively: pelvis (69, 112), proximal (102, 141), rib (105, 109+), distal (226+, 240), and other (96+, 199+). Females had better prognoses than males; the median survival times were 197 and 147 weeks, respectively. An abnormal liver function as indicated by an abnormal serum glutamic-oxaloacetic transaminase value (greater than 45 IU) was a bad prognostic sign, although only 8 patients had this finding; their median survival time was 94 weeks. Patients who had resections had a slight advantage in survival compared with those having biopsies, though the difference favoring resection patients was not consistent for both sexes in any primary site. Individual characteristics of the patients that were of prognostic significance were: blood lymphocyte counts (high counts favorable), polymorphonuclear leukocyte counts (high counts unfavorable), and time from symptoms to diagnosis (times less than 1 mol favorable). Patients who received treatment 2 had significantly poorer prognoses than those given treatments 1 or 3. The median disease-free and survival times by treatment were (in wk): 1 (134, 198+), 2 (81, 120), and 3 (123, 182).     

脑胶质瘤致癫痫发作的危险因素分析

目的：探讨导致胶质瘤患者癫痫发作的多种危险因素,并对这些危险因素进行分析。方法：回顾性分析2006年1月至2008年11月,于我科经手术病理证实为胶质瘤的159例患者的临床资料,根据患者的临床资料,采用SPSS统计软件,对导致癫痫的有统计学差异的筛选变量进行Logistic多元回归分析。结果：肿瘤大小（β=0．547）,瘤周水肿带大小（β=1．166）,肿瘤病理级别（β=-0．803）是导致癫痫发作的具有统计学意义的因素,其优势比（OR）分别为1．729、3．210、0．448。结论：肿瘤大小,瘤周水肿带大小,肿瘤病理级别是导致癫痫发作的重要因素。     

腹腔镜手术对结直肠癌患者疼痛因子及血清炎症因子的影响

目的 研究腹腔镜手术对结直肠癌患者疼痛因子及血清炎症因子的影响.方法 将120例结直肠癌患者按照治手术方式的不同分为观察组(n=58)和对照组(n=62),对照组采用常规开腹手术治疗,而观察组采用腹腔镜手术治疗.比较两组患者住院费用,围手术期指标(手术时间、术中出血量、肛门排气时间、出院时间),疼痛因子水平[前列腺素E2(PGE2)、神经生长因子(NGF)、神经肽Y(NPY)],炎症因子水平[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)]及并发症的发生情况.结果 两组患者住院费用比较,差异无统计学意义(P﹥0.05).观察组患者术中出血量明显少于对照组(P﹤0.01),手术时间、首次肛门排气时间、出院时间均明显短于对照组(P﹤0.01).术后,两组患者PGE2、NGF、NPY水平均明显高于本组术前(P﹤0.01),但观察组患者PGE2、NGF、NPY水平均低于对照组(P﹤0.05).术后,两组患者TNF-α、IL-6、IL-1β水平均明显高于本组术前(P﹤0.01),但观察组患者TNF-α、IL-6、IL-1β水平均明显低于对照组(P﹤0.01).观察组患者并发症总发生率低于对照组(P﹤0.05).结论 与开腹手术相比,结直肠癌患者应用腹腔镜手术可减少术中出血量,缩短手术时间、首次肛门排气时间、出院时间,降低机体炎症反应程度、疼痛程度及并发症的发生风险.