妊娠滋养细胞肿瘤合并肾上腺转移患者的治疗和预后分析  

Clinical Management and Prognosis of Gestational Trophoblastic Neoplasma Patients Complicated with Adrenal Metastasis

作　　者：仓唯 杨隽钧[1] 向阳[1] 万希润 冯凤芝[1] 任彤[1] 赵峻[1] Cang Wei;Yang Junjun;Xiang Yang;Wan Xirun;Feng Fengzhi;Ren Tong;Zhao Jun(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and PekingUnion Medical College,Beijing100730,China)

机构地区：[1]中国医学科学院/北京协和医学院/北京协和医院妇产科,北京100730

出　　处：《肿瘤预防与治疗》2021年第5期420-424,共5页Journal of Cancer Control And Treatment

基　　金：国家自然科学基金(编号:81972451)。

摘　　要：目的:探讨和分析妊娠滋养细胞肿瘤(gestational trophoblastic neoplasma,GTN)合并肾上腺转移患者的治疗和预后.方法:回顾收集2006年1月至2018年12月北京协和医院收治的GTN合并肾上腺转移患者9例,并对其治疗方法及预后进行分析.结果:9例患者均合并有肺转移.除肺转移外,1个部位转移1例、2个部位转移2例、3个部位转移6例.9例患者入院后均接受了多药联合化疗,包括FAV、FAEV、EMA/CO、EMA/EP等,4例脑转移患者同时接受甲氨蝶呤鞘内注射化疗.4例患者接受化疗的同时接受手术治疗,包括肺切除3例次,肾上腺切除2例次,子宫切除2例次.6例患者经过治疗后完全缓解,1例部分缓解,2例疾病进展.结论:GTN合并肾上腺转移罕见.由于肾上腺转移患者往往同时合并肝、脑等多器官转移,通常预后较差.化疗是主要治疗手段,部分患者经过化疗后可达到治愈.对于耐药患者,手术切除耐药病灶可明显改善预后.对于难治性GTN患者也可考虑免疫治疗.Objective:To investigate and analyze the clinical efficacy and prognosis of gestational trophoblastic neoplasma(GTN)patients with adrenal metastasis.Methods:Clinic al characteristics and prognosis of 9 GTN patients complicated with adrenal metastasis admitted to Peking Union Medical College Hospital from January 2006 to December 2018 were retrospectively analyzed.Results:All patients were diagnosed with pulmonary metastasis.Apart from adrenal gland and lung,metas-tases were also observed in one organ in 1 patient,two organs in 2 patients,and three organs in 6 patients.All patients received multi-drug chemotherapy,including FAV,FAEV,EMA/CO,EMA/EP therapies,etc.Among them,4 patients underwent surgeries simultaneously(lobe resections in 3 cases,adrenal mass resections in 2 cases,hysterectomies in 2 cases).4 patients with brain metastasis received intrathecal administration of methotrexate.Complete response was observed in 6 patients,partial response in 1 patient,and progressive disease in 2 patients.Conclusion:GTN complicated with adrenal metastasis is rarely reported,which usually accompanies multiple organ lesions including liver and brain,and the prognosis of these patients is poor.Chemotherapy is the main treatment for GTN,and part of the patients would attain complete remission after chemotherapy.For patients with drug resistance,surgical resection can obviously improve prognosis.In addition,for pa tients with refractory GTN,immunotherapy may be considered.

关 键 词：妊娠滋养细胞肿瘤 肾上腺转移 预后 治疗 

分 类 号：R737.7[医药卫生—肿瘤] R737.31[医药卫生—临床医学]