妊娠滋养细胞肿瘤复发的相关因素分析和治疗

Management and risk factors of recurrent gestational trophoblastic tumor

目的 分析妊娠滋养细胞肿瘤（GTT）复发患者的治疗、预后以及复发的相关因素。方法 1985年1月至2004年1月共收治1130例滋养细胞肿瘤患者，其中有901例患者获得完全缓解（CR）；所有CR患者中有31例复发，对这些患者的资料进行回顾性分析。结果 GTT患者的总体复发率为3．4％。有4例患者为多次复发（2～3次），共复发7例次，再复发率为22．6％（7／31）；复发时间为停药后的6—72个月（平均15．3个月）。所有复发患者中有25例再次接受了治疗，其中18例（72％）经过治疗后完全缓解，3例获得部分缓解，4例死亡。复发的高危因素主要为：临床分期（P〈0．05），末次妊娠终止至化疗的时间〉12个月（OR=3．170，P〈0．05），化疗7个疗程以后血人绒毛膜促性腺激素B亚单位（13-hCG）降至正常（OR=4．775，P〈0．05）和巩固少于2个疗程（OR=0．441，P〈0．05）。结论 对于初治的GTY患者应重视与复发相关的各种高危因素，避免复发的发生。而对于复发后的患者应用多药化疗联合手术治疗可以提高治愈率，降低再复发率。

Objective To analyze the management, prognosis and prognostic risk factors of recurrent gestational trophoblastic tumor （GRIT） . Methods One thousand one hundred and thirty GrIT patients, aged 29 ±6, were hospitalized and treated and 901 of them got complete remission （CR）. Among these CR patients, 31 suffered relapsed. The clinical data of these 31 cases were analyzed retrospectively. Results Thirty-one patients suffered 15.3 months （6～72 months） after the cessation of treatment with an overall recurrence rate of 3.4% （31/901 ）. Four of the 31 patients suffered relapse repeatedly （ totally seven times） , resulting in an overall re-recurrence rate of 22.6% （7/31 ）. Twenty-five of the 31 patients were rehospitalized and received treatment. Eighteen of them got complete remission （ CR）, 3 got partial remission （PR）, and 4 died of progress of the disease （PD）. The major adverse prognostic risk factors included： clinical stage （ P 〈 0. 05 ） , an interval of more than 12 months from the antecedent pregnancy to chemotherapy （ OR = 3. 170, P 〈 0.05 ）, declination of β-hCG level hack to normal titer after more than seven courses of chemotherapy （ OR = 4. 775, P 〈 0. 05 ）, and less than two courses of consolidation chemotherapy （ OR = 0.441, P 〈 0.05 ）. Conduslon More attention should be given to those GTT patients with adverse prognostic risk factors. Multi-drug and multiple route chemotherapy and/or combined surgical intervention can be used to improve the cure rate and lower the re-recurrence rate of the GTT recurrent patients.