足月产后绒毛膜癌患者的临床特征与预后分析

目的分析足月产后绒毛膜癌患者的临床特征、治疗和预后情况。方法回顾性分析了北京协和医院1985年12月至2005年6月间收治的103例足月产后绒毛膜癌患者的临床特征、治疗和预后情况。结果103例足月产后绒毛膜癌患者经过以化疗为主的综合治疗后,92例（89．3％）患者获得完全缓解,2例部分缓解,9例疾病进展死亡。92例完全缓解的患者中有4例复发,经过再次治疗3例完全缓解,1例死亡。103例患者中,25例出现耐药,经化疗或联合手术治疗后18例完全缓解,2例部分缓解,5例死亡。本组患者按2000年国际妇产科联盟（FIGO）标准,临床分期：Ⅰ期17例、Ⅱ期8例、Ⅲ期56例、Ⅳ期22例,各期的完全缓解率分别为100％、8／8、95％和64％,Ⅰ、Ⅱ、Ⅲ期的完全缓解率分别与Ⅳ期比较,差异均有统计学意义（P〈0．05）;预后评分：低危型（预后评分≤6分）35例,高危型（预后评分≥7分）68例,其完全缓解率分别为100％和84％,两者比较,差异有统计学意义（P〈0．05）。结论提高足月产后绒毛膜癌的早期诊断率、采用联合化疗为主的多途径综合治疗、重视耐药和复发患者的治疗将明显提高足月产后绒毛膜癌的治愈率。

Clinical characters and prognosis of postpartum choriocarcinoma

OBJECTIVE: To analyze the clinical characters and prognosis of postpartum choriocarcinoma. METHODS: Retrospective analysis of 103 patients diagnosed with postpartum choriocarcinoma in Peking Union Medical College Hospital between 1985 and 2005 was performed. RESULTS: In a total of 103 cases of postpartum choriocarcinoma treated with multiagent cytotoxic chemotherapy and combined modality therapy, 92 patients (89.3%) achieved a complete remission while 2 patients had a partial remission, and 9 patients died. Regarding 25 cases with chemorefractory choriocarcinoma and 4 relapsed cases, 18 and 3 cases achieved a complete remission respectively. According to the new International Federation of Gynecology and Obstetrics (FIGO) 2000 staging and risk factor scoring system, 17 cases were at FIGO stage I, 8 cases at stage II, 56 cases at stage III, and 22 cases at stage IV. Complete remission was achieved in 100%, 8/8, 95% and 64% respectively. Thirty-five cases in low risk group had FIGO scores < or = 6, and all achieved a complete remission. Of 68 cases in high risk group with FIGO scores > or = 7, 57 (84%) of them obtained a complete remission. There were significant differences in the two groups (P < 0.05). CONCLUSION: Postpartum choriocarcinoma could have an increasing probability of cure with early diagnosis and the use of modern multiagent cytotoxic chemotherapy and combined modality therapy.