妊娠滋养细胞肿瘤临床分期与预后评分系统(FIGO 2000)再评价

Evaluation of the FIGO 2000 staging and risk factor scoring system for gestational trophoblastic neoplasia

目的评价FIG02000妊娠滋养细胞肿瘤分期与预后评分系统对妊娠滋养细胞肿瘤治疗和预后的指导意义。方法回顾性分析2002-01-01—2013—12—31在北京协和医院妇产科滋养细胞疾病诊治中心诊治的恶性妊娠滋养细胞肿瘤患者1420例。年龄（30．9±7．9）岁。治疗的终点事件为血清学完全缓解。随访中位时间40个月（6-163个月），评价不同分期及不同预后评分患者的治疗情况，并评价每个预后因素的预测效力。结果（1）总体治愈率89．2％，病死率5．5％，疾病复发94例，疾病进展60例。中位无病生存期36个月（0～163个月）。（2）I期407例（28．7％），Ⅱ期27例（1．9％），Ⅲ期902例（63．5％），Ⅳ期84例（5．9％），随期别升高，各期别患者病死率、复发率、进展率升高，组间比较差异有统计学意义（P〈0．05）。（3）低危患者（0-6分）治愈率97．6％（895／917），高危患者（〉6分）治愈率73．8％（371／503），两者相比P〈0．001；低危组和高危组病死率分别为0．3％和15．1％（P〈0．001）。（4）年龄、化疗前血β-人绒毛膜促性腺激素（β-HCG）水平、肿瘤最大直径均不是预后（治愈率）的独立危险因素；末次妊娠性质、化疗距终止妊娠时间、转移病灶数和先前化疗失败史是预后的独立危险因素。（5）是否存在阴道或盆腔转移对预后没有显著影响。肺、脾、肾、胃肠道、肝、脑等部位存在转移时，预后都显著变差，不同部位的转移对预后影响差异较大。结论FIGO2000妊娠滋养细胞肿瘤临床分期与预后评分系统的精确性和可操作性需要进一步改进，预后评分系统申有些因素可能不是预后的独立危险因素。

Objective To evaluate the application of the Federation of Gynecology and Obstetrics （FIGO）2000 staging and risk factor scoring system in the management and prognosis of gestational trophoblastic neoplasia.Methods Retro- spective review of 1420 eases, aged 30.9 ± 7.9 years old, treated between Jan 1 st, 2002 and 31 st Dee, 2013 in the GTD center of Peking Union Medical Hospital （PUMCH）, was performed. The terminal events were defined as serum complete remission. The median follow-up time was 40 months （ranging 6-163 months）. The management of different FIGO scoring/staging cases and the predictive validity of prognostic factors were evaluated. Results 1. Overall survival was 89.2% and the disease-related mortality was 5.5%, with 94 cases of recurrent disease and 60 cases of progressing dis- ease. The median disease-free interval was 36 months （ranged from 0-163 months）. 2. Totally 407 cases of stage I （28.7%）, 27 cases of stage Ⅱ （1.9%）, 902 cases of stage Ⅲ （63.5%） and 84 cases of stage 1V （5.9%）were analyzed. With the advancement of stage, the rate of mortality, recurrence and progression were significantly increased. 3. The cure rate of the high risk （score≥7） group was 73.8 % （ 371/503 ）, which was significantly lower than that of the low risk （ score≤6） group （97.6%, 895/917） , and the mortality rate was repectively 15.1% and 0.3% （P〈0.001）. 4. Univariate analysis revealed that patient＇ s age, pre-treatment serum HCG level and the largest tumor size were not indepen- dent risk factors of prognosis. Multivariate Cox analysis confirmed that antecedent pregnancy, interval months from index pregnancy, number of metastases and previous failed chemotherapy were independent prognostic factors. 5. There was no influence on cure rate when vaginal or pelvic metastases occurred. Any other site of metastases, including lungs, spleen, kidney, gastrointestinal tract, liver and brain, predicted a significantly worse prognosis. Different site of metastases had a different influence on prognosis.Conclusion The current FIGO 2000 staging and risk factor scoring system is effective and well directed. However the accuracy and practicality of the stage and risk factor scoring system need to be improved, and some predicable factors might not be the independent risk factors of prognosis.