40岁以上葡萄胎患者的临床和预后因素分析

Hydatidiform mole in women aged 40 or more

目的 评价40岁以上葡萄胎(HM)患者的临床生物学行为、预后以及影响预后的因素。方法 回顾性分析北京协和医院16年问收治的40岁以上HM24侧的临床资料,并进行统计学分析。结果 24例患者中,年龄41-55岁,平均(47±4)岁。β-HCG水平为(2.2-98.9)×104mIU/ml,平均(30.7±32.2)×105mIU/ml。所有患者均进行了清官术,完全性葡萄胎15例,部分性葡萄胎9例,其中14例(58.3％)在清官术前1-3天即开始了化疗,8例在清宫术后开始化疗。19例进行了子宫切除术,其中术前β-HCG水平降至正常者4例,术前仍异常者15例,8例病理检查有阳性发现,11例无阳性发现。发生恶变者11例。对于可能影响预后的各因素进行分析发现,本病的恶变与清宫前是否行化疗(P<0.05)、子宫切除术前β-HCG水平是否正常(P<0.01)以及子宫切除术病理检查结果是否有阳性发现(P<0.05)有较明显的相关性。结论 40岁以上HM患者的恶变率高,早期诊断及清宫前即开始化疗,可以明显降低恶变率,改善疾病的预后。

To evaluated clinico - biologic feature, prognosis and relative prognostic factors of hydatidi form mole in women aged 40 or more. Methods The clinical records of hydatidiform mole in women aged 40 or more, who received treatment in Oeking Union Medical College Hospital from 1987 to 2002, were reviewed retrospectively. The data were analyzed statistically by SPSS. Results Among 24 cases, the median age was 47± (41-45) yearold. The median level of β - HCG was (30.7 ± 32.2) × 104 [ (2.2-98.9) ×104] mIU/ml. All patients underwent evacuation of hydatidform mole. Pathologic results showed that complete hydatidiform mole and partial hydatidiform mole were 15 and 9 respectively, 14 (58∧3%) cases were given chemotherapy at one to three days before the beginning of molar evacuation, and 8 cases∧ after evacuation. Hysterectomy was performed in 19 cases. Pathology results showed that positive and negative findings were in 8 and 11 cases, respectively. 11 patients with invasive mole were demonstrated. The possible prognostic factors were analyzed and revealed that chemotherapy before molar evacuation ( P < 0.05) , the level of β - HCG before hysterectomy ( P < 0.01) and the pathologic findings of uterus ( P < 0.05) were the most important prognostic factors. Conclusions Malignant transformation of hydatidiform mole in women aged 40 or more was increased, and reduced significantly by early diagnosis and chemotherapy before molar evacuation.