妊娠滋养细胞肿瘤化学治疗预后的相关因素分析

Related factors of prognosis of patients with gestational trophoblastic neoplasia after chemotherapy

目的探讨影响妊娠滋养细胞肿瘤(GTN)化学治疗预后的相关临床因素。方法回顾性分析2009―2016年我院收治的55例妊娠滋养细胞疾病患者的病例资料,其中葡萄胎26例、GTN 29例(侵蚀性葡萄胎23例、绒毛膜癌6例),将经化学治疗后连续3次随访血人绒毛膜促性腺激素(HCG)<5 U/L的23例GTN患者纳入研究。对年龄、生育史、是否有肺转移、FIGO分期等可能影响GTN患者治愈时间的临床因素进行Cox回归分析,对年龄和生育史与治愈时间的关系进行Kaplan-Meier生存分析。结果 Cox回归单因素分析发现足月产史、流产史与治愈时间有关(P均<0.05),年龄接近有统计学意义(P=0.051);多因素分析显示足月产史是GTN治愈时间的独立影响因素(P=0.020)。Kaplan-Meier生存分析发现GTN治愈时间与年龄(P=0.043)、足月产史(P=0.016)、流产史(P=0.026)有关。结论对于年龄大、有过足月产史或流产史的妇女,均应警惕GTN的发生,其治愈时间长,需密切监测血HCG的动态变化。

Objective To explore the clinical factors influencing the prognosis of patients with gestational trophoblastic neoplasia(GTN)after chemotherapy.Methods The clinical data of 55 patients with gestational trophoblastic diseases in our hospital from 2009 to 2016 were retrospectively analyzed,including 26 cases with hydatidiform mole and 29 cases with GTN(23 cases of invasive mole and 6 cases of choriocarcinoma).Among them,23 GTN patients with the follow-up human chorionic gonadotropin(HCG)<5 U/L for 3 times after chemotherapy were included in this study.The age,reproductive history,lung metastasis,International Federation of Gynecology and Obstetrics(FIGO)stage and other clinical factors which might affect the cure time of GTN patients were analyzed by Cox regression analysis.The relationship between age and reproductive history and cure time were analyzed by Kaplan-Meier survival analysis.Results Cox regression univariate analysis showed that term delivery and abortion were related to the cure time of GTN patients(both P<0.05),and the age was close to statistical significance(P=0.051).Cox multivariate analysis showed that term delivery was an independent factor influencing the cure time of GTN patients(P=0.020).Kaplan-Meier survival analysis showed that age(P=0.043),term delivery(P=0.016)and abortion(P=0.026)were related to the cure time of GTN patients after chemotherapy.Conclusion Older women or women who have histories of term delivery or abortion should be alerted to the occurrence of GTN,which has long cure time and the dynamic changes of blood HCG need to be closely monitored.