影响绒毛膜癌预后因素的分析与防治

目的 :探讨绒毛膜癌 (绒癌 )影响预后的高危因素 ,并提出防治措施。方法 :对 64例绒癌患者的临床资料进行回顾性分析 :5 8例接受正规化治疗 ,必要时辅以超选择性动脉插管灌注化疗或手术 ,分析临床疗效及毒副反应 ,并比较影响疗效的高危因素。结果 :5 8例患者中 ,5 2例有效 ,6例耐药 ,总有效率 89.7% ( 5 2 / 5 8)。有效组与耐药组的年龄比较 ,差异有高度显著性 (P <0 .0 1) ,两组血HCG比较 ,差异有显著性 (P <0 .0 5 ) ,两组间比较子宫大小及子宫动脉RI值 ,差异无显著性 (P >0 .0 5 )。Ⅰ、Ⅱ期总有效率 94 .6%。Ⅲ期由原来单用静脉化疗的 78.9%升至89.5 %。白细胞水平在 1、2、3组方案中分别为 ( 2 .0 4± 0 .5 3 )× 10 9/L、( 2 .76± 0 .2 6)× 10 9/L、( 1.5 2± 0 .2 8)× 10 9/L。结论 :患者年龄、血HCG与耐药性的产生有关。高危及耐药性绒癌可用EMA/CO化疗 ,且联合超选择性动脉插管灌注化疗及手术 ,能进一步改善治疗效果。治疗中注意观察白细胞水平 ,避免严重的骨髓抑制。

Relationship between the Prognosis of Choriocarcinoma and Risk factors

Objective: To analyze the clinical course of choriocarcinoma(CC) and identify the risk drug resistant factors.Methods: 64 cases were diagnosed as CC in past 3 years.Among them,58 patients were treated with different regimen.Selective arterial infusion as adjuncts to chemotherapy and (or) operative excision were performed. The response and toxicity were assessed after treatment.The high risk drug resistant factors were investigated.Results: Fifty-two cases (89.7%) obtained remission, while 6 cases showed drug resistant.The median age of effective group was less than that of drug resistant group( P <0.01). HCG decreased in drug resistant group as compared with effective group( P <0.05).The effective rate increased from 78.9% to 89.5% because of using the selective arterial infusion chemotherapy.The main complications for chemotherapy were myelosuppression. Conclusion:The age and HCG have some connection with the prognosis of choriocarcinoma. Chemotherapy is an effective treatment for CC and the chemotherapeutic results can be further improved while combined with arterial infusion chemotherapy and surgery in the selected patients. The level of blood WBC is very important during the treatment.