妊娠滋养细胞肿瘤化学治疗预后的相关因素分析

目的 探讨影响妊娠滋养细胞肿瘤化疗的相关临床因素。方法 回顾性分析2009-2016年我院收治的53例妊娠滋养细胞疾病病历资料，其中葡萄胎26例，侵蚀性葡萄胎23例，绒毛膜癌6例。对经化疗后随访连续3次血HCG＜5mIU/ml的23例妊娠滋养细胞肿瘤（GTN）患者的年龄、生育史、是否有肺转移、FIGO分期进行比较,对其治疗结果进行分析。结果 Kaplan Meier生存分析发现GTN化疗治愈时间与年龄(<30岁) (P=0.043)；足月产史(P=0.016)；流产史 (P=0.026)相关；Cox回归单因素分析发现足月产史、流产史与预后有关（均P＜0.05）。多因素分析显示足月产史(P=0.022)是GTN预后的独立因素。结论 对于年龄大、有过足月产史及流产史的妇女，均应警惕妊娠滋养细胞肿瘤的发生，其治愈时间长，需密切监测血HCG的动态变化。

Related factors of prognosis of patients with gestational trophoblastic neoplasia after chemotherapy

Objective To explore the clinical factors influencing the prognosis of patients with gestational trophoblastic neoplasia (GTN) after chemotherapy. Methods The clinical data of 55 patients with gestational trophoblastic diseases in our hospital from 2009 to 2016 were retrospectively analyzed, including 26 cases with hydatidiform mole and 29 cases with GTN (23 cases of invasive mole and 6 cases of choriocarcinoma). Among them, 23 GTN patients with the follow-up human chorionic gonadotropin (HCG)<5 U/L for 3 times after chemotherapy were included in this study. The age, reproductive history, lung metastasis, International Federation of Gynecology and Obstetrics (FIGO) stage and other clinical factors which might affect the cure time of GTN patients were analyzed by Cox regression analysis. The relationship between age and reproductive history and cure time were analyzed by Kaplan-Meier survival analysis. Results Cox regression univariate analysis showed that term delivery and abortion were related to the cure time of GTN patients (both P<0.05), and the age was close to statistical significance (P=0.051). Cox multivariate analysis showed that term delivery was an independent factor influencing the cure time of GTN patients (P=0.020). Kaplan-Meier survival analysis showed that age (P=0.043), term delivery (P=0.016) and abortion (P=0.026) were related to the cure time of GTN patients after chemotherapy. Conclusion Older women or women who have histories of term delivery or abortion should be alerted to the occurrence of GTN, which has long cure time and the dynamic changes of blood HCG need to be closely monitored.