妊娠滋养细胞肿瘤泌尿系统及肾上腺转移患者的治疗及疗效分析

Analysis of the treatment and prognosis for gestational trophoblastic neoplasia patients with urinary system and adrenal glands metastasis

目的 探讨有泌尿系统及肾上腺转移的妊娠滋养细胞肿瘤（GTN）患者的治疗方法及疗效.方法 收集1990年12月至2010年12月中国医学科学院北京协和医院妇产科收治的32例有泌尿系统及肾上腺转移的GTN患者的临床资料,对这些患者的治疗及疗效进行回顾性分析.结果 （1）治疗方法：32例患者中,所有患者均接受了1～ 24个疗程（平均9.0个疗程）多药联合化疗,其中有3例膀胱转移患者在全身化疗的同时予氟尿嘧啶膀胱内灌注化疗;24例患者接受了手术治疗,其中9例患者在外院、15例患者在本院.（2）治疗效果：32例患者中,21例（66％）患者获得完全缓解,3例（9％）患者获得部分缓解,8例（25％）患者病情进展.其中,13例肾转移患者中,7例获得完全缓解;5例肾上腺转移患者中,2例获得完全缓解;11例膀胱转移患者中,9例获得完全缓解;7例输尿管转移患者全部获得完全缓解.21例完全缓解患者中,有2例（10％）复发.结论 多药多途径联合化疗仍是GTN泌尿系统及肾上腺转移患者的主要治疗方法.对于合并肾或肾上腺转移的GTN患者,由于其常合并远处多器宫转移,预后较差,应予重视,采用个体化治疗,适时辅助手术治疗,以进一步改善其疗效.

Objective To analyze the treatment and prognosis of patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis.Methods The treatment and prognoses of 32 patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis from Dec.1990 to Dec.2010 at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences were respectively reviewed.Results Treatment methods：all 32 patients received 9 courses（in average） of a multi-drug chemotherapy in our hospital （range 1-24 coures）.Among them,3 patients with bladder metastasis received intravesical chemotherapy of fluorouracil.9 patients received surgical treatments in other hospital and 15 patients received surgical treatments while undergoing chemotherapy in our hospital.Treatment results：after the treatments,of the 32 patients,21 （66%） patients achieved complete remission,3（9%） exhibited partial remission and 8 （25%） progressed.Seven patients with renal metastasis achieved complete remission.Two patients with adrenal glands metastasis achieved complete remission.Nine patients with urinary bladder metastasis achieved complete remission.Seven patients with ureters metastasis achieved complete remission.Two （10%） of 21 patients with complete remission relapsed.Conclusions Multidrug and muhiroute chemotherapy is the main strategy for patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis.The prognoses of patients with renal or adrenal glands metastasis are much worse than those in patients with bladder and ureters metastasis because of concomitant multiogran metastasis.Adequate attention should be given to patients with renal or adrenal glands metastasis.Individual treatment,assisted by surgery when necessary,may be carried out for these patients to achieve a better outcome.