复发性滋养细胞肿瘤预后因素分析

目的对影响滋养细胞肿瘤复发患者预后的因素进行分析,为临床复发患者的治疗及预后评估提供参考。方法回顾性分析1995年1月至2013年12月在北京协和医院接受治疗、至少复发1次且在本院随诊的滋养细胞肿瘤患者。采用SPSS 13.0软件,对复发患者的预后影响因素,包括年龄、末次妊娠性质、转移部位、FIGO分期、评分、首次术前β-HCG水平、首次术前化疗种类、化疗疗程、术后病理等进行分析。结果共纳入86例患者,复发患者的总完全缓解率为84.9%(73/86);单因素分析结果表明,初次于外院复发(P=0.038)及首次复发时间≤3个月(P=0.045)是影响复发患者的不良预后因素;多因素Cox回归模型的预后分析结果表明,首次复发发生于外院(P=0.025)、年龄≥31岁(P=0.048)是复发患者的不良预后因素。结论大多数复发患者能够通过化疗、手术与放疗的联合治疗治愈,对于有不良预后因素的患者仍期待有新的治疗方案。

Analysis of prognostic factors for relapsed gestational trophoblastic neoplasia

Objective:To analyze retrospectively the prognosis factors of replased gestational trophoblastic neoplasia (GTN) in order to provide clinical reference for the patients' treatment.Methods:The patients with gestational trophoblastic neoplasia who had recurrence at least once and followed-up in Peking Union Medical College Hospital from January 1995 to December 2013 were included in the study.The following variables were assessed as potential prognostic factors of relapse in univariate and multivariate (Cox model) analysis:age,antecedent pregnancy,FIGO staging and score,initial serum β-HCG level,type of the first preoperative chemotherapy,chemotherapy course,etc.Results:Eighty six patients were included in the study,and 84.9% (73/86) of the relapsed patients achieved serous complete remission (SCR).The results of univariate analysis showed that the primary relapse occurred in the other hospitals (73±3.2 vs.130±31 months,χ2=4.792 P=0.038) and the first recurrence time≤3 months (69±10.4 vs.79±6.7 months,χ2=4.021 P=0.045) were the important prognosis factors of re-recurrence.Multivariate analysis showed that age≥31 years (χ2=3.897,P=0.048;95%CI:0.268~0.995) and the primary relapse occurred in the other hospitals (χ2=5.042,P=0.025;95%CI:0.168~0.886) were the important prognosis factors of re-recurrence.Conclusions:The most patients with relapsed gestational trophoblastic neoplasia can be cured by combined treatment with chemotherapy,surgery and radiotherapy,but novel therapies are required for the refractory patients.