有恶变高危因素的葡萄胎患者预防性化疗的结局及临床特点分析

Analysis of prophylactic chemotherapy outcome and clinical characteristics in patients of high-risk hydatidiform mole

目的 分析有恶变高危因素的葡萄胎患者行预防性化疗的结局及临床特点.方法 回顾性分析2005年1月至2008年1月间在北京协和医院妇产科行清宫术后病理检查诊断为葡萄胎,并因具有高危因素而行预防性化疗的患者共23例,预防性化疗方案为单药化疗,如出现单药耐药即诊断为预防性化疗失败,葡萄胎患者发生了恶变,随后给予双药或多药联合方案化疗.其中,预防性化疗成功11例（成功组）,失败12例（失败组）,比较两组患者的临床特点及预防性化疗结局.结果 成功组和失败组患者的中位年龄分别为33.1和30.0岁,中位停经时间分别为12.3和12.1周,子宫增大至相应停经周数4周以上者分别为4/11和4/12,单侧卵巢囊肿直径≥6cm或有双侧卵巢囊肿者分别为1/11和4/12,以上指标两组间分别比较,差异均无统计学意义（P＞0.05）.成功组与失败组清宫术前血清β-hCG的中位水平分别为469 144和768 044 U/L,开始治疗至首次血清β-hCG水平降到正常水平（正常≤2 U/L）的中位治疗时间分别为71和120 d,两组分别比较,差异均有统计学意义（P＜0.05,P＜0.01）.受试者工作特征（ROC）曲线分析显示,血清β-hCG水平可作为提示预后的指标;以750 000 U/L作为截距值,其特异度为91%,敏感度为58%.结论 对于血清β-hCG水平高于750 000 U/L的葡萄胎患者,需要进行预防性化疗,最好直接采用双药或多药联合方案的化疗,以利于缩短治疗时间及预防耐药.

Objective To analyze prophylactic chemotherapy outcome and clinical characteristics in patients of high-risk hydatidiform mole. Methods Twenty-three patients who were diagnosed as high-risk hydatidiform mole and undergone prophylactic chemotherapy in our hospital were retrospectively analyzed. After prophylactic chemotherapy, 11 patients didn＇t develop to gestational trophoblastic neoplasia （GTN） , while the other 12 patients developed to GTN and needed a regimen change to combination chemotherapy. The clinical characteristics of these patients and outcome of prophylactic chemotherapy were compared between two groups. Results There was no significant difference between the two groups on patients＇ age, weeks of delayed menses, enlarged uterine size excessive for gestational age, and incidence of theca-lutein cysts of ovaries. However,the median levels of pre-evacuation serum β-hCG in two groups were 469 144 U/L and 768 044 U/L respectively, and median days needed for β-hCG declining to normal（ 42 U/L） at the first time were 71 and 120 days respectively, which were both significantly different between two groups. Analyzed with receiver operating charactristic （ ROC ） , the level of serum β-hCG could be a predictor for prognosis. Choosing 750 000 U/L as the cut-off value, we could expect the serum β-hCG to have a specificity of 91% and a sensitivity of 58% to predict whether prophylactic chemotherapy will be successful. Conclusions For those patients who have to receive prophylactic chemotherapy because of risk factors and unavailable hCG assessments for follow-up, it＇s better to use double-agent or combination chemotherapy if the level of serum β-hCG reached 750 000 U/L so as to reduce therapy duration and prevent relevant chemoresistance.