高危因素对葡萄胎后恶变影响的临床分析

Effect of High Risk Factors on Postmolar Canceration

目的:探讨高危因素对葡萄胎后恶变的影响。方法:分析比较有高危因素与无高危因素葡萄胎后妊娠滋养细胞肿瘤(GTN)的临床特点。结果:72例恶变病例中有高危因素57例,无高危因素15例。先期葡萄胎合并各种高危因素组的恶变率明显高于未合并高危因素组,差异均有统计学意义(P<0.05)。有无高危因素葡萄胎后GTN距先期妊娠时间差异有统计学意义(P<0.05)。除阴道流血外,有高危因素的GTN患者出现其他症状明显多于无高危因素的GTN患者。有无高危因素葡萄胎后GTN患者GTN分期的分布差异无统计学意义(P>0.05),预后评分为高危GTN患者差异有统计学意义(P<0.05)。有无高危因素低危GTN组中初次治疗使用MTX单药方案缓解率差异无统计学意义,改为ACTD方案后缓解率差异亦无统计学意义(P>0.05)。结论:对葡萄胎患者高危因素进行正确评估,及时行预防性化疗或手术,葡萄胎后GTN患者对其高危因素结合FIGO分期及WHO改良预后评分进行评估,以选择合适的化疗方案及疗程、手术时机及病例。重视葡萄胎的高危因素有助于诊治GTN和提高疗效。

Objective：To evaluate the effects of high risk factors on postmolar canceration. Methods：The clinical features of postmolar gestational trophoblastic neoplasia （GTN） with and without high risk factors were compared and analyzed. Results：Among the 72 postmolar GTN patients, the number of patients with and without high risk factors was 57 and 15, respectively. Malignant transformation rate in patients with former hydatidiform mole combined with high risk factors was significantly higher than patients without high risk factors （P0.05）. The interval between antecedent pregnancies and postmolar GTN had statistically significant differences between the patients with and without high risk factors （P0.05）. However, though the clinical symptoms in patients with high risk factors were more than that in patients without high risk factors（except vaginal bleeding）,there was no significant difference（P0.05）. The distribution of postmolar GTN stages was no significant difference between the two groups（P0.05） while the prognosis score did （P0.05）. There was no significant difference in remission rate between the two groups when patients accepted initial therapy of MTX. However, when using ACTD, there was still no statistical differences （P0.05）.Conclusions：The high risk factors should be estimated exactly for the patients with hydatidiform mole. In addition, the prophylactic chemotherapy and surgery should be carried out on time. The patients can be estimated exactly and given the best chemotherapy methods, course and surgery time via combing with the high risk factors, FIGO stage and the modified WHO prognostic index score system together. Taking seriously to the patients with high risk factors will be helpful for the therapy of postmolar GTN.