妊娠滋养细胞肿瘤疗效及预后分析—北京协和医院初治患者回顾性队列研究

发布时间：2018-03-16 13:46

  本文选题：妊娠滋养细胞肿瘤　切入点：分期　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：目的:探讨1985-2015年在北京协和医院妇产科滋养细胞疾病诊治中心接受初始治疗的妊娠滋养肿瘤(GTN)患者的疗效,分析影响GTN患者预后的危险因素。方法:回顾性分析1985年1月至2015年12月间在北京协和医院接受初始治疗的妊娠滋养细胞肿瘤患者共1711例,其中1985-2001年545例,2002-2015年患者1166例。比较各年代不同诊断、分期及根据FIGO(2000)预后评分系统不同评分危险分层的患者的疗效,并通过多因素COX回归分析影响患者预后的危险因素及各因素的风险比(HR)。结果:1.总体1985-2015年我院初治GTN患者完全缓解(CR)率为96.3%(1648/1711例),1985-2001 年组 CR 率为 93.6%(510/545 例),2002-2015 年组为 97.6%(1138/1166 例),P0.001。2.总体初治GTN患者死亡率为2.57%(44/1711例),复发率为2.71%(45/1663例)。3.总体侵袭性葡萄胎(IM)患者CR率98.5%(1012/1027例),绒毛膜癌(CC)患者CR率93.0%(636/684例),CC患者的预后较IM患者差,HR=4.884(95%CI:2.735-8.721),P0.001,2002-2015 年组 IM 与 CC 的 CR 率均高于1985-2001 年组。4.总体I期患者511例(29.9%),II期患者57例(3.3%),III期患者1048例(61.3%),IV期患者95例(5.6%);2002-2015年组I期、II期、IV期患者比例均少于1985-2001年组,III期患者比例高于1985-2001年组;两年代组IV期患者预后最差,但2002-2015 年组(76.5%)好于 1985-2001 年组(59.1%),P0.001。5.总体低危患者(0-6分)和高危患者(≥7分)的CR率分别为98.7%(1342/1359)和 86.9%(306/352),HR=11.092(95%CI:6.357-19.353),P0.001。6.FIGO(2000)的预后评分系统中年龄(是否≥40)、末次妊娠性质(葡萄胎或非葡萄胎)、转移部位(是否有除肺以外的远处转移)是影响预后的独立危险因素;而妊娠终止距化疗开始时间、化疗前hCG水平、肿瘤最大直径、转移数目虽单因素分析后结果有意义,但多因素分析结果显示它们并不是影响预后的独立危险因素。结论:GTN患者在经过及时规范的单/多药化疗后可以获得十分满意的疗效,我院初治GTN患者的CR率近十余年来进一步提高。FIGO(2000)预后评分系统中有些因素或不是影响预后的独立危险因素,尚需进一步修订简化。
[Abstract]:Objective: to investigate the effect of initial treatment on GTNN of gestational trophoblastic neoplasms (GTNN) in gynecology and obstetrics trophoblastic disease center of Peking Union Hospital from 1985 to 2015. Methods: 1 711 patients with gestational trophoblastic tumor who received initial treatment in Peking Union Hospital from January 1985 to December 2015 were analyzed retrospectively. Among them, 545 patients from 1985 to 2001 had 1166 patients from 2002 to 2015. The curative effect of patients with different diagnosis, stage and risk stratification according to Figo 2000 prognostic scoring system was compared. Multivariate COX regression analysis was used to analyze the risk factors affecting patients' prognosis and the risk of each factor. Results: 1: 1.The overall complete remission rate of GTN patients in our hospital from 1985 to 2015 was 96. 3% 1648 / 1711. From 1985 to 2001, the CR rate was 93.610 / 545 in 2002-2015 and 97.638 / 1166 in 2002-2015. The overall mortality rate of patients with GTN was 2.57 / 44 / 1711, and the recurrence rate was 2.71 / 45 / 1663. The CR rate of total invasive hydatidiform mole (IMI) patients was 98.555 / 1027, and the CR rate of patients with choriocarcinoma was 93.036 / 684. The prognosis of patients with CC was worse than that of IM patients. The CR rate was higher than that in 1985-2001 group .511 patients with stage I and 57 patients with stage II were 1048 patients with stage I and stage III, 95 patients with stage I and stage IV were lower than those with stage III in 1985-2001. The proportion of patients with stage III of stage I was lower than that of group III (1985-2001). The prognosis of stage IV patients in two years group was the worst. But 2002-2015 was better than 1985-2001 (P 0.001.5) and high-risk patients (鈮，

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