妊娠滋养细胞肿瘤患者的死亡原因及相关因素分析

目的探讨妊娠滋养细胞肿瘤患者的死亡原因及相关因素。方法自1985年1月至2004年1月,北京协和医院共收治妊娠滋养细胞肿瘤患者1130例,其中死亡患者64例,本研究对这些患者的死亡原因及相关因素进行回顾性分析。结果64例死亡患者中,初治失败死亡58例,缓解后复发死亡6例;初治失败死亡患者的主要死亡原因为多器官功能衰竭、颅内出血或合并脑疝形成、化疗副反应;缓解后复发死亡患者的死亡原因为复发后病情进展。对初治失败患者的死亡原因进行单因素和多因素分析发现,初治失败患者的死亡与末次妊娠终止至化疗开始的时间（OR=2．857,P〈0．01）、血人绒毛膜促性腺激素β亚单位（β-hCG）水平（P〈0．05）、临床病理类型（OR=3．635,P〈0．05）、临床分期（P〈0．05）以及器官转移数目（OR=2．201,P〈0．01）、耐药（OR=0．181,P〈0．01）有关。结论妊娠滋养细胞肿瘤治疗前应对患者进行正确评估,重视与死亡相关的各种高危因素,以进一步改善患者预后。

Analysis of death causes of gestational trophoblastic neoplasia patients

OBJECTIVE: To analyze retrospectively the causes of death in gestational trophoblastic neoplasia (GTN) patients. The prognostic risk factors were also discussed. METHODS: One thousand one hundred and thirty GTN patients were hospitalized and treated at Peking Union Medical College Hospital from 1985 to 2004. Sixty-four of them died later and retrospective analyses were carried out on these patients. RESULTS: Fifty-eight out of the 64 patients died during initial treatment. The other six died from disease relapse and progression of the disease (PD). The major causes of death were multi-organ failure, intracranial haemorrhage, cerebral herniation, side-effects of chemotherapy, and PD after relapse. The result of multivariate analysis indicated the adverse prognostic factors included the interval between antecedent pregnancy and chemotherapy treatment (OR = 2.857, P < 0.01), the titer of beta subunit of human chorionic gonadotropin (beta-hCG, P < 0.05), the diagnosis of choriocarcinoma (OR = 3.635, P < 0.05), clinical stage (P < 0.05), multiple metastases (OR = 2.201, P < 0.01) and drug resistance (OR = 0.181, P < 0.01). CONCLUSIONS: A proper evaluation of a GTN patient before initial treatment is important. More attention should be paid to the death-related prognostic risk factors to improve the prognosis of high risk GTN patients.