耐药性妊娠滋养细胞肿瘤肺转移患者血β-HCG正常后肺叶切除术的价值探讨  

Value of Pulmonary Lobectomy in the Treatment of Chemorefractory Gestational Trophoblastic Neoplasia with Lung Metastasis within Normal Range of Serum-HCG

作　　者：王永学[1] 冯凤芝[1] 向阳[1] 马丽[1] 万希润[1] 

机构地区：[1]北京协和医学院中国医学科学院北京协和医院,北京100730

出　　处：《实用妇产科杂志》2010年第11期849-852,共4页Journal of Practical Obstetrics and Gynecology

基　　金：国家科技支撑计划课题基金(编号:2008BAI57B05)

摘　　要：目的:探讨耐药性妊娠滋养细胞肿瘤(GTN)肺转移患者血清β-HCG正常后行肺叶切除的治疗价值。方法:回顾性分析1995年1月至2008年12月间在北京协和医院接受肺叶切除手术联合化疗治疗的耐药性GTN肺转移46例患者的临床病理资料,并对术前血β-HCG水平已经降至正常和尚未正常的患者进行比较。结果:21例(45.7%)患者术前血β-HCG水平正常(2U/L),25例(54.3%)术前未正常。两组在年龄、末次妊娠性质、术前化疗疗程数等方面差异均无统计学意义。治疗后血清学完全缓解共40例(90.9%,40/44),4例患者无效;血β-HCG正常组和异常组的血清学完全缓解率分别为95%(19/20)和88%(21/24)(P=0.614)。术后病理阳性率为47.8%(22/46);血清学完全缓解的40例患者阳性率为47.5%(19/40);血β-HCG正常组和异常组的病理阳性率分别为28.6%(6/21)和64%(16/25),差异有统计学意义,P=0.021。血β-HCG水平正常后并已经巩固化疗>1疗程的11例患者中仍有27.3%(3/11)的病理阳性率。结论:肺叶切除术联合化疗治疗耐药性GTN肺转移患者可以获得满意的疗效;即使通过补救化疗使血β-HCG降至正常的患者仍有近1/3的病理阳性率,适时行肺叶切除术可以提高疗效。Objective：To investigate the value of pulmonary lobectomy in the treatment of chemorefractory gestational trophoblastic neoplasia （GTN） with lung metastasis within normal range of serum β-ΗCG. Methods：The clinico-pathological features of 46 patients with chemorefractory GTN and lung metastasis who underwent pulmonary lobectomy and combination chemotherapy at Peking Union Medical College Hospital from Jan 1995 to Dec 2008 were retrospectively reviewed. And,the patients with normal preoperative β-ΗCG level were compared with the patients with abnormal preoperative β-ΗCG level. Results：Of the 46 cases,21（45.7%） cases manifested normal preoperative β-ΗCG level （〈2I U/L） while the other 25 cases were abnormal（〉2I U/L）. There was no significantly statistical difference in age,character of antecedent pregnancy,courses of preoperative chemotherapy between these two groups. At the completion of treatment,40 patients achieved serum complete remission （SCR） （90.9%,40/44）,4 cases had no response to treatment. The rate of SCR in normal β-ΗCG and abnormal β-ΗCG group was 95% （19/20） and 88% （21/24）,respectively （P=0.614）. The positive rate of pathology was 47.8% in 46 patients（22/46）. In the 40 cases of SCR,the positive rate of pathology was 47.5%（19/40）. The positive rate of pathology between the normal β-ΗCG group and abnormal group had significantly statistical difference,with 28.6% （6/21） and 64% （16/25）,respectively,P=0.021. The positive rate of pathology remained to be 27.3% （3/11）in 11 patients who had received at least 2 courses of consolidation chemotherapy and had normal β-ΗCG level before lobectomy.Conclusions：Pulmonary lobectomy combination with chemotherapy is effective in the treatment of chemorefractory GTN with lung metastasis. But almost 1/3 patients who has normal serum β-ΗCG after salvage chemotherapy have positive pathology. For these patients,pulmonary lobectomy at appropriate time could improve the SCR.

关 键 词：妊娠滋养细胞肿瘤 化疗耐药 肺叶切除 

分 类 号：R737.33[医药卫生—肿瘤]