绒毛膜癌复发的影响因素分析

目的对绒毛膜癌的疗效及预后进行分析,并探讨绒毛膜癌复发的影响因素.方法对北京协和医院诊治的490例绒毛膜癌患者的临床资料进行回顾性分析.结果共有394例初治患者获得完全缓解,其中17例复发,复发率为4.3%;17例复发患者中,国际妇产科联盟（FIGO）预后评分为低危患者5例,低危复发率为2.4%（5/208）,高危患者12例,高危复发率6.5%（12/186）;巩固疗程为0个疗程、1个疗程的患者复发率分别为6.1%（3/49）、9.8%（6/61）,巩固2个疗程、3个疗程以及＞3个疗程的患者复发率分别为1.4%（1/70）、3.9%（2/51）和3.1%（5/163）;13例（76.5%,13/17）患者在3年内复发,4例3年后复发;17例复发患者经治疗后有16例（94.1%）完全缓解,其中6例（37.5%,6/16）完全缓解后再次复发,另1例部分缓解后自动出院而失访.外院治疗后复发转入我院的患者21例,共计38例复发患者,其中29例1次复发,7例2次复发,2例4次复发,总复发次数为51例次.51例次复发的治疗中,单纯使用化疗者的完全缓解率为69.2%（18/26）,再次复发率为50.0%（9/18）;化疗结合手术治疗者的完全缓解率为92.0%（23/25）,再次复发率为17.4%（4/23）.结论初治时FIGO预后评分为高危及巩固化疗不足2个疗程,是与绒毛膜癌复发明确相关的因素;3年内复发的患者占多数,但仍有3年后复发的患者;复发患者属高危人群,应积极治疗,化疗结合手术治疗是提高缓解率,降低再次复发率的重要手段.

Factors related to recurrence of choriocarcinoma and evaluation of treatment outcomes

Objective To analyse the factors associated with recurrence of choriocarcinoma and to evaluate the treatment outcomes of choriocarcinoma. Methods The records of 490 patients with choriocarcinoma treated at Peking Union Medical College Hospital (PUMCH) were reviewed and evaluated for recurrent episodes of choriocarcinoma. Results Three hundred and ninety-four women achieved primary remission; 17 (4.3%) developed one or more episodes of recurrent choriocarcinoma. Recurrent rate in low-risk patients was 2.4% (5/208), while in high-risk patients 6.5% (12/186). Recurrent rates among those without and with 1 course of maintenance chemotherapy patients were 6.1% (3/49) and 9.8% (6/61) respectively, while in 2, 3, and >3 courses of maintenance therapy patients were 1.4% (1/70), 3.9% (2/51) and 3.1% (5/163) respectively. Thirteen (76.5%,13/17)patients with recurrent choriocarcinoma recurred within 3 years and 4 patients after 3 years. Sixteen (94.1%) of 17 patients achieved secondary remission; 6 (37.5%) of 16 developed a second recurrence, and one was lost to follow-up after partial remission. In addition, 21 patients were referred to PUMCH from other hospitals for salvage therapy at the time of recurrence. Totally 38 patients of recurrent choriocarcinoma were treated at our hospital; 29 recurred once, 7 recurred twice and 2 recurred 4 times. There were totally 51 instances treated for recurrent choriocarcinoma. The complete remission rates in patients using chemotherapy only was 69.2% (18/26), the second recurrent rates of these patients was 50.0% (9/18); the complete remission rates in patients using chemotherapy combined with surgery was 92.0% (23/25), the second recurrent rates of these patients was 17.4% (4/23). Conclusions Factors related to development of recurrent choriocarcinoma include high-risk at initial evaluation and less than two courses of maintenance chemotherapy beyond the primary remission. Most patients of recurrent choriocarcinoma recur within 3 years; the recurrent choriocarcinoma is of poor prognosis and should be treated aggressively. Chemotherapy combined with surgery is the most important method to increase cure rates and to decrease recurrent rates.