40岁以上妊娠滋养细胞肿瘤患者的临床特征及预后分析  

Clinical characteristics and prognosis of patients with gestational trophoblastic neoplasia aged 40 or more

作　　者：余慧[1] 王伟红 熊莉莉 刘英 谷小雅 安瑞芳[1] Yu Hui;Wang Weihong;Xiong Lili(Department of Obstetrics and Gynecology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061;Northwest Women's and Children's Hospital,Xi'an 710003)

机构地区：[1]西安交通大学第一附属医院妇产科,西安710061 [2]西北妇女儿童医院,西安710003

出　　处：《现代妇产科进展》2021年第7期488-492,共5页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金资助项目(No:81972428);西安交通大学第一附属医院院基金(No:2019QN-20)。

摘　　要：目的:探讨40岁以上妊娠滋养细胞肿瘤(GTN)患者的临床特征、治疗方法及预后情况。方法:回顾分析2008年1月至2019年12月西安交通大学第一附属医院妇科收治的82例年龄≥40岁GTN患者的临床资料,用Kaplan-Meier法绘制无进展生存期(PFS),Cox风险比例回归模型进行PFS的单因素分析和多因素分析。结果:患者年龄40~58岁,中位年龄45.5岁,主要临床表现为阴道出血,误诊率高达19.51%,最终确诊侵蚀性葡萄胎51例Ⅰ期26例,Ⅲ期25例,FIGO评分(4.73±2.48)分,绒毛膜癌31例Ⅰ期12例,Ⅲ期16例,Ⅳ期3例,FIGO评分(10.1±4.90)分。患者均根据评分接受化疗,共化疗422疗程,平均5.1疗程;56例患者接受化疗联合全子宫切除术。平均随访25.1月,7例复发,6例死亡,72例治愈,治愈率为87.80%。单因素Cox回归分析发现,年龄≥40岁GTN患者的预后危险因素有产次>3次、发病距先期妊娠时间>18月、最大肿瘤直径≥5cm、脑转移、转移灶数目、先前化疗失败史、诊断为绒毛膜癌、FIGO评分≥7分。多因素Cox回归分析发现,年龄≥40岁GTN患者的预后危险因素是产次>3(HR=7.50,95%CI为1.33~42.16)和发病距先期妊娠时间>18月(HR=16.21,95%CI为3.39~77.45)。结论:年龄≥40岁妇女发生阴道出血时,应考虑与GTN鉴别,血β-HCG和盆腔B超有助于诊断。绒毛膜癌比侵蚀性葡萄胎发病距离先期妊娠时间长、β-HCG水平高、FIGO评分高、预后差。产次>3次和发病距先期妊娠时间>18月是影响年龄≥40岁GTN患者预后的独立危险因素。Objective:To explore the clinical characteristics,treatment and prognosis of patients with gestational trophoblastic neoplasia(GTN)aged 40 or more.Methods:The clinical datas of 82 patients with GTN aged 40 or more in the First Affiliated Hospital of Xi'an Jiaotong University from January 2008 to December 2019 were analyzed retrospectively.Progression-free survival was estimated by Kaplan-Meier analysis.Cox regression univariate and multivariate analysis was done to test the significance of prognostic factors for PFS.Results:Elderly patients with GTN were between 40~58 years old and the meadian was 45.5 years old.The common clinical manifestation of GTN was vaginal bleeding and the misdiagnosis rate was 19.51%.There were 51 cases of invasive mole(stageⅠ:26 cases,stageⅢ:25 cases,the average FIGO score=4.73±2.48)and 31 cases of choriocarcinoma(stageⅠ:12 cases,stageⅢ:16 cases,stageⅣ:3 cases,the average FIGO score=10.1±4.90).All the GTN patients accepted chemotherapy according to the FIGO score.The total number of chemotherapy course was 422 and the average course was 5.1.56 patients accepted chemotherapy in combination with surgery.Mean follow-up time was 25.1 months.7 patients relapsed,6 patients died and 72 patients were cured.The cure rate was 87.80%.There were lots of the risk factors influencing the prognosis of patients with GTN aged 40 or more,including parity>3,interval from index pregnancy longer than 18 months,tumor size≥5cm,brain metastasis,number of metastases,previous failed chemotherapy,the diagnosis of choriocarcinoma,and the FIGO score≥7.In multivariate analysis,independent risk factors for GTN patients aged 40 or more were parity>3(HR 7.50,95%CI 1.33~42.16)and interval from index pregnancy longer than 18 months(HR 16.21,95%CI 3.39~77.45).Conclusions:Women aged 40 or more with vaginal bleeding should be considered for identification with GTN,which bloodβ-HCG concentration and pelvic ultrasound examination will be helpful.Patients with choriocarcinoma had longer interval from index pre

关 键 词：妊娠滋养细胞肿瘤 40岁以上 化疗 全子宫切除术 无进展生存期 

分 类 号：R737.33[医药卫生—肿瘤]