妊娠滋养细胞肿瘤Ⅳ期患者的治疗和预后分析

Management and prognosis in stage Ⅳ gestational trophoblastic neoplasia patients

目的探讨和分析妊娠滋养细胞肿瘤Ⅳ期患者的治疗和预后。方法1985年1月至2004年1月北京协和医院收治了妊娠滋养细胞肿瘤患者1130例,其中Ⅳ期患者92例,对这些患者的治疗及预后情况进行回顾性分析。结果92例Ⅳ期患者中,有4例(4%)入院后尚未接受化疗即死亡,其余88例均接受了多药联合化疗,化疗方案采用以氟尿嘧啶为主的联合化疗方案,化疗途径主要是静脉途径以及动脉插管化疗;有32例(35%,32/92)患者在接受化疗的同时还予以手术治疗。92例患者经过治疗后33例获得完全缓解(CR),37例部分缓解,22例病情进展。CR患者中3例复发。所有患者中共有33例死亡。92例患者中,70例患者有1个或2个脏器的转移,其中27例(39%,27/70)获得CR,20例(29%,20/70)死亡;出现3个脏器转移的17例患者中5例(29%,5/17)获得CR,10例(59%,10/17)死亡;≥4个脏器转移的5例患者中,1例获得CR,3例死亡。转移脏器数量的多少与患者的预后相关(P=0·034),也与死亡相关(P=0·018)。结论多药、多途径联合化疗辅助手术治疗是改善Ⅳ期患者预后的主要方法,对于不同脏器转移的治疗应该采用个体化方式。随着转移脏器数量的增加,缓解率明显降低。

Objective To analyze the management and prognosis in stage Ⅳ gestational trophoblastic neoplasia （GTN） patients. Methods One thousand one hundred and thirty GTN patients were hospitalized and treated at Peking Union Medical College Hospital from year 1985 to 2004. Ninety-two of them were diagnosed as stage Ⅳ of GTN. Retrospective analyses were carried out on these patients in terms of management and prognosis. Results Of the 92 patients who had undergone treatment, complete remission （CR） was achieved in 33, partial remission in 37, and progress of the disease was seen in 22. Among all the CR patients, three had recurrence later. Thirty-three out of all the patients died during or after treatment. Among the 92 cases, 70 had one or two metastases, of whom 27 had CR, and 20 died. Of the 17 cases who had three metastases, 5 achieved CR, and 10 died. Of the five cases with ≥4 metastases, one had CR, and three died. The number of metastatic organs was correlated with prognosis （ P = 0. 034） and death （P = 0. 018 ）. Conclusions Multi-drug and multi-route chemotherapy and （or） combined surgical intervention may improve the survival rate of the stage Ⅳ GTN patients. The management should be individualized for different patients with metastases. With the increase in the number of metastatic organs, the remission rate decreases.