耐药和复发性妊娠滋养细胞肿瘤的临床病例分析

摘要

Objective To analyze and compare the clinical characteristics and the treatment outcome of the patients with chemo-resistant and relapsed gestational trophoblastic neoplasia (GTN).Methods The clinical records of the patients with refractory GTN treated at the Peking Union Medical College Hospital (PUMCH) from Jan 2005 to Dec 2007 were retrospectively reviewed.According to the reasons for referral, all cases were classified as chemo-resistant GTN group who had never a normal serum human chorionic gonadotropin-beta subunit (β-hCG) level during their previous treatment, relapsed GTN group who had elevated serum β-hCG levels in the absence of the pregnancy after finished treatment 3 months or more, and undetermined GTN group who had elevated serum β-hCG levels in the absence of the pregnancy less than 3 months after completed treatment.The clinical features and treatment outcomes were compared between undetermined GTN group and chemo-resistant GTN group and also between undetermined GTN group and relapsed GTN group, respectively.Results Of 81 patients with refractory GTN, 32 cases were defined as undetermined GTN, 38 cases as chemo-resistant GTN and 11 cases as relapsed GTN.The median number of previous chemotherapy regimens, the rate of serologic complete remission ( SCR), the patients who needed to change regimens due to resistance, and the patients who needed to change regimens in the undetermined GTN group and the chemo-resistant GTN group were 2.3 versus 3.1 ( P = 0.010),100% (32/32) versus 66% (25/38, P ＜ 0.01 ), 22% (7/32) versus 58% (22/38, P = 0.002) and 28% (9/32) versus 63% (24/38, P = 0.003 ), respectively.No significant difference were observed between undetermined GTN group and relapsed GTN group in clinical features, previous and current treatment or treatment outcome ( all P ＞0.05 ).Conclusions In order to evaluate accurately the treatment outcome of refractory GTN, it seems more appropriate for the patients who had reached the normal value of serum β-hCG when completed treatment to be defined as patients with relapsed GTN, while whose serum β-hCG levels elevated in the absence of the pregnancy after the completion of treatment, irrespectively of duration of stopping treatment.Comparing with the patients with chemo-resistant GTN, the outcome of patients with relapsed GTN is better.%目的 总结分析耐药和复发性妊娠滋养细胞肿瘤(GTN)的临床特点和治疗效果.方法 回顾性分析2005年1月至2007年12月间,北京协和医院收治的难治性GTN患者的临床资料.并对既往治疗过程中血清人绒毛膜促性腺激素β亚单位(β-hCG)水平达到正常水平,而在停化疗3个月内开始再次升高且除外再次妊娠的患者(不确定组),分别与文献中普遍承认的既往治疗过程中血清β-hCG水平从未达到过正常的耐药组、及既往治疗过程中血清β-hCG水平达到正常水平而停化疗3个月后开始再次升高且除外再次妊娠的复发组的临床特点及治疗效果进行比较.结果 因既往治疗失败而转诊至本院的难治性GTN患者共81例,其中耐药组38例,不确定组32例,复发组11例.不确定组、耐药组患者的既往化疗方案种类的中位数、血清学完全缓解率、治疗过程中因化疗效果不满意更改方案率及总体更改方案率分别为2.3和3.1个、100%(32/32)和66%(25/38)、22%(7/32)和58%(22/38)、28%(9/32)和63%(24/38),两组分别比较,差异均具有统计学意义(P＜0.05).而不确定组的32例患者与复发组的11例患者相比,其临床特点(包括年龄、末次妊娠性质、妊娠终止至化疗开始的时间间隔、转移部位、预后评分)、既往治疗情况(包括既往化疗的疗程数和方案种类数)、本院首选化疗方案、手术治疗情况、更改化疗方案情况及治疗结局间均无差异(P＞0.05).结论 为准确评价难治性GTN患者的治疗效果,对于因血清β-hCG水平达到完全缓解后,在停止治疗3个月内发生血清β-hCG水平再次升高、且排除再次妊娠的患者,归为复发病例更为合适,复发与停止治疗后的时间长短无关.与耐药患者相比,复发患者的预后较好.