妊娠滋养细胞肿瘤患者血hCG转阴时间的相关因素分析  

Analysis of predictors of the time to hCG remission in patients with gestational trophoblastic neoplasia

作　　者：罗勤 孙欣慰 韩健 郭建新 LUO Qin;SUN Xinwei;HAN Jian;GUO Jianxin(Department of Obstetrics and Gynecology,Army Specialty Medical Center,Chongqing 400042,China)

机构地区：[1]陆军特色医学中心妇产科,重庆400042

出　　处：《重庆医学》2024年第3期423-430,共8页Chongqing medicine

基　　金：陆军特色医学中心人才创新能力培养计划(2019CXLCC003)。

摘　　要：目的探讨与妊娠滋养细胞肿瘤(GTN)患者人绒毛膜促性腺激素(hCG)转阴时间相关的预测因素,以明确化疗后hCG的下降速率(HDPCR)是否能预测患者hCG转阴时间。方法回顾性分析2010—2020年该院收治的121例GTN患者的病例资料,均最后1次化疗后再随访6个月。对患者年龄、前次妊娠性质、距前次妊娠时间、治疗前血hCG水平、病理诊断、国际妇产科联合会(FIGO)预后评分、是否有转移病灶、子宫病灶最大径、一线化疗方案、HDPCR及hCG转阴前是否行子宫切除术等可能影响血hCG转阴时间的临床因素进行Kaplan-Meier生存分析及Cox回归分析。结果患者中位血hCG转阴时间为85 d;中位血hCG转阴疗程数为3个疗程。Kaplan-Meier生存分析结果显示,距前次妊娠时间、治疗前血hCG水平、一线化疗方案、第1个疗程化疗后hCG的下降速率(HDPCR1)、第2个疗程化疗后hCG的下降速率(HDPCR2)及hCG转阴前是否行子宫切除术均与血hCG转阴时间有关(P<0.05)。Cox回归分析结果显示,治疗前血hCG高水平(HR=0.627,95%CI:0.501~0.786)是血hCG转阴时间较长的独立危险因素,HDPCR1(HR=1.843,95%CI:1.342~2.531)及HDPCR2越高(HR=1.380,95%CI:1.012~1.882)是血hCG转阴时间较长的保护因素(P<0.05)。前次妊娠性质、距前次妊娠时间、FIGO预后评分、子宫病灶最大径、一线化疗方案均与HDPCR1有关(P<0.05)。结论治疗前血hCG水平越高,血hCG转阴时间越长;HDPCR越高,血hCG转阴时间越短。Objective To explore the predictive factors associated with the time to human chorionic gonadotropin(hCG)remission in patients with gestational trophoblastic neoplasia(GTN),in order to determine whether the hCG decrease post chemotherapy rate(HDPCR)can predict the time required for hCG remission in GTN patients.Methods A retrospective analysis was conducted on clinical data of 121 cases of GTN patients admitted to this hospital from 2010 to 2020.After each patient’s final chemotherapy session,a six-month follow-up ensued.Patient age,nature of previous pregnancies,time passed since the previous pregnancy,pre-treatment hCG blood levels,pathological diagnosis,International Federation of Obstetrics and Gynecology(FIGO)score,presence of metastatic lesions,maximum diameter of uterine lesions,first-line chemotherapy regimen,HDPCR,and whether to perform hysterectomy before hCG remission,which could potentially impact the time to hCG remission,were subjected to Kaplan-Meier survival analysis and Cox regression analysis.Results Among the included patients,the median time to hCG remission was 85 days,the median chemotherapy course to hCG remission was 3.Kaplan-Meier survival analysis revealed that the time passed since the previous pregnancy,pre-treatment hCG blood levels,first-line chemotherapy regimen,hCG decrease post 1st chemotherapy rate(HDPCR1),hCG decrease post 2nd chemotherapy rate(HDPCR2)and whether to perform hysterectomy before hCG remission were all associated with the time to hCG remission(P<0.05).Cox regression analysis indicated that higher pre-treatment hCG blood levels(HR=0.627,95%CI:0.501-0.786)was an independent risk factor for longer time to hCG remission,faster HDPCR1(HR=1.843,95%CI:1.342-2.531)and HDPCR2(HR=1.380,95%CI:1.012-1.882)were protective factors for longer time to hCG remission(P<0.05).The nature of previous pregnancy,the time passed since the previous pregnancy,FIGO score,maximum diameter of uterine lesions,and the first-line chemotherapy regimen were all associated with the HDPCR1(P<0.05).

关 键 词：妊娠滋养细胞肿瘤 人绒毛膜促性腺激素 hCG转阴时间 预后因素 生存分析 COX比例风险回归模型 

分 类 号：R737.33[医药卫生—肿瘤]