恶性滋养细胞肿瘤的疗效和预后因素分析

目的:回顾分析1985年至2004年北京协和医院收治的恶性滋养细胞肿瘤患者的治疗和预后情况,并探讨影响其预后的相关因素。方法:1985年1月至2004年1月我院收治恶性滋养细胞肿瘤患者1 130例,其中侵蚀性葡萄胎(IM)患者614例,绒癌(CC)患者516例。其中高危患者325例,低危患者805例。回顾分析这些患者的治疗和预后,探讨影响预后的因素。结果:1 130例患者中903例(80.0%)获得完全缓解,187例(16.5%)获部分缓解,40例(3.5%)患者病情进展,64例患者(5.0%)在治疗中或病情缓解复发后死亡。CR患者中31例(3.4%)在停药后4个月~6年复发,共复发38例次。187例PR患者中155例患者(82.0%)经过化疗后β-hCG降至正常,但转移灶缩小至一定程度后未再有明显变化带瘤出院,其中17例患者未随诊,138例均定期随诊,其中84例随诊期间转移灶无明显变化,48例转移灶消失或缩小,此外6例(3.9%)绒癌患者在停药6~8个月后β-hCG升高,病情进展。通过统计学分析表明其与所有CR患者及合并肺转移的CR患者的预后之间均无明显的统计学差异(P>0.05)。随诊患者中139例患者停药后共妊娠159次,其中废胎率16.4%(26/159),葡萄胎率3.1%,胎儿畸形率1.6%(1/61)。结论:GTN患者经适时、规范的化疗多可治愈。对于高危和耐药的患者应采用多药联合及多途径方案化疗,对一些选择性病例同时辅助手术治疗,可提高治愈率。对于β-hCG正常后并经巩固化疗,转移灶不再变化的患者可认为是治愈而密切随诊。建议有生育要求的患者在停药1年后妊娠,并加强产前检查以预防发生异常妊娠。

The management and prognosis of gestational trophoblastic neoplasia

Objective:To analyze retrospectively the management and prognosis of gestational trophoblastic neoplasia(GTN) patients treated at Peking Union Medical College Hospital from 1985 to 2004.The adverse prognostic risk factors were discussed.Methods:One thousand one hundred and thirty GTN patients were treated.Among them,614 were invasive mole,and 516 patients were choriocarcinoma.There were 325 high-risk patients,and the rest of them were low-risk patients.The management and prognosis of all the patients were retrospectively analyzed.The analyses of prognostic factors were performed by using univariate and multivariate analyses.Results:Among 1 130 patients,903(80.0%)got complete remission(CR),187(16.5%)got partial remission(PR),and 40(3.5%) died of progress of the disease(PD).Of all the patients,sixty-four cases died(5.0%) during or after treatment.Among all the CR patients,thirty-one of them(3.4%)relapsed later(totally 38 recurrences),and the recurrence occurred four months to six years after ceasing the treatment.Of the 187 PR patients,one hundred and fifty-five(82.0%) had got normal β-hCG titer,but with residual tumor in the lung or other organs.Among them,84 patients' metastatic tumors remained as the same size as before,48 patients' metastatic tumors were disappeared or reduced,and the other six choriocarcinoma patients got PD after treatment.There were one hundred and thirty-nine patients becoming pregnant during their follow-ups,with a total number of 159 pregnancies.Among them,abnormal pregnancies rate was 16.4%(26/159),molar rate was 3.1%,and fetal abnormality rate was 1.6%(1/61).Conclusions:Most GTN patients can be cured if they can receive chemotherapy treatment in a timely and accurate way,with the right regimen in regular interval and dosage.In the high-risk and drug-resistance patients,the successful treatment can be achieved by multi-drug and multiple route chemotherapy.In selected cases,adjuvant surgery should also be applied to achieve better curative effect.For those patients whose residual metastatic tumors have no change after receiving consolidation chemotherapy after serum β-hCG returned to normal,the authors assume that they have got complete remission,but need to be followed frequently.As pregnancies occurring within 12 months following remission are at risk of abnormality,a waiting period of at least 12 months after chemotherapy for GTN is recommended.