妊娠滋养细胞肿瘤患者的死亡原因及相关因素分析

Analysis of death causes of gestational trophoblastic neoplasia patients

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。

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 β subunit of human chorionic gonadotropin （ β-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. 151, P 〈 0. 01 ）. Conclusions A proper evaluation of a GTN patient before initial treatment is important. More attention should he paid to the death-related prognostic risk factors to improve the prognosis of high risk GTN patients.