非葡萄胎妊娠后绒毛膜癌的临床诊疗特征及预后影响因素分析

Analysis of clinical diagnosis and treatment characteristics and prognostic factors influencing the prognosis of non-molar gestational choriocarcinoma

摘要

目的 探讨非葡萄胎妊娠后绒毛膜癌的临床特征、治疗方法及预后情况。方法 选取2008年1月1日至2022年1月1日在西安交通大学第一附属医院妇科住院的非葡萄胎妊娠后绒毛膜癌患者81例,对其临床特征及预后影响因素进行回顾性分析。结果 81例患者的中位年龄为35(28,43)岁,主要临床表现为阴道流血,所有患者均接受化疗,其中6例患者的初治化疗方案为单药方案[甲氨蝶呤(MTX)或5-氟尿嘧啶(5-FU)],56例患者为5-FU、MTX联合依托泊苷(VP-16)化疗方案(简称三联方案),11例患者为EMA/CO[VP-16、MTX、放线菌素D(Act-D)/环磷酰胺(CTX)、长春新碱(VCR)]方案,8例患者为其他方案(5-FU联合Act-D或5-FU、MTX联合Act-D).有29例患者在化疗同时辅以手术治疗.中位随访时间为92(64,124)个月,有66例患者达到完全缓解,治愈率81.48%,12例(14.82%)患者发生疾病进展或复发,3例患者死亡(3.70%).多因素Logistic回归分析显示,患者40岁以上(OR=5.040,95%CI:1.147~22.149,P=0.032),转移瘤数目>8个(OR=21.946,95%CI:1.083~444.740,P=0.044),5-FU、MTX联合VP-16化疗方案(OR=0.034,95%CI:0.004~0.296,P=0.002)均为影响非葡萄胎妊娠后绒毛膜癌预后的因素.在国际妇产科联盟(FIGO)评分低于7分的患者中,与单药和其他方案相比,三联方案治愈率更高(P=0.002);在FIGO评分为7~12分的患者中,三联方案的治愈率高于单药、EMA/CO及其他方案(P=0.006)。结论 非葡萄胎妊娠后绒毛膜癌整体治愈率较高,患者40岁以上、转移瘤数目>8个均是影响非葡萄胎妊娠后绒毛膜癌预后的不利因素,5-FU、MTX联合VP-16化疗方案可提高其治愈率,且尤适用于FIGO评分低于13分的患者.

Abstract

Objective To study and analyze the clinical features, treatment modalities and prognosis of non-molar gestational choriocarcinoma. Methods A retrospective analysis was conducted on 81 patients with non-molar gestational choriocarcinoma, who were admitted to the Department of Obstetrics and Gynecology, Xi′an Jiaotong University First Affiliated Hospital, from January 1, 2008, to January 1, 2022. The clinical features and factors affecting prognosis were analyzed. Results The median age of the 81 patients was 35 (28, 43) years, with the main clinical manifestation being vaginal bleeding. All patients received chemotherapy, of which 6 patients received a single-drug chemotherapy regimen [methotrexate (MTX) or 5-fluorouracil (5-FU)] as the first-line treatment, 56 patients received a combination regimen of 5-FU, MTX, and etoposide-16 (VP-16) (referred to as the triplet regimen), 11 patients received the EMA/CO regimen [VP-16, MTX, actinomycin D (Act-D)/cyclophosphamide (CTX), vincristine (VCR)], and 8 patients received other regimens (5-FU combined with Act-D or 5-FU, MTX combined with Act-D). Additionally, 29 patients received surgery in combination with chemotherapy. The median follow-up time was 92 (64, 124) months. Complete remission was achieved in 66 patients, with a cure rate of 81.48%. 12 patients (14.82%) had disease progression or recurrence, and 3 patients died (3.70%). Multivariate logistic regression analysis revealed that age over 40 years (OR=5.040, 95%CI: 1.147-22.149, P=0.032), number of metastatic tumors >8 (OR=21.946, 95%CI: 1.083-444.740, P=0.044), and the combination chemotherapy regimen of 5-FU, MTX, and VP-16 (OR=0.034, 95%CI: 0.004-0.296, P=0.002) were factors influencing the prognosis of non-molar gestational choriocarcinoma. Among patients with a FIGO score of less than 7, the triplet regimen had a higher cure rate compared to single-drug and other regimens (P=0.002). In patients with a FIGO score of 7-12, the triplet regimen had a higher cure rate than single-drug, EMA/CO, and other regimens (P=0.006). Conclusion The overall cure rate of non-molar gestational choriocarcinoma is high. Age over 40 years and the number of metastatic tumors >8 are adverse factors affecting the prognosis of non-molar gestational choriocarcinoma. The combination chemotherapy regimen of 5-FU, MTX, and VP-16 can improve the cure rate, especially for patients with a FIGO score of less than 13.

关键词

非葡萄胎妊娠后绒毛膜癌 / 妊娠滋养细胞疾病 / 化疗 / 妊娠滋养细胞肿瘤

Key words

non-molar gestational choriocarcinoma / gestational trophoblastic disease / chemotherapy / gestational trophoblastic neoplasia

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基金资助

国家自然科学基金资助项目(81972428)

陕西省自然科学基础研究资助项目(2021JMG282)