论文部分内容阅读
目的分析妊娠滋养细胞肿瘤肺转移患者经规范治疗后,血人绒毛膜促性腺激素β亚单位(β-hCG)水平降至正常,但肺内阴影持续存在患者的预后。方法 1985年1月至2004年1月间北京协和医院共收治了妊娠滋养细胞肿瘤患者1130例,其中获得完全缓解(CR)患者901例,获得部分缓解(PR)患者187例。901例 CR 患者中合并肺转移者463例;187例 PR 患者中152例经规范化疗后血β-hCG 水平降至正常,但肺内转移灶未完全吸收而带瘤出院随诊。本研究对上述152例肺内带瘤出院患者的临床资料进行回顾性分析,并分别与同期出院的901例 CR 患者以及合并肺转移的463例 CR 患者的预后进行比较。结果 152例患者均接受了规范的多疗程多药联合化疗1～30个疗程(平均3.6个疗程)后血β-hCG 水平降至正常,然后又接受了0～8个疗程(平均3.7个疗程)的巩固化疗而带瘤出院。152例肺内带瘤出院患者中,除17例患者未随诊外,其余135例患者均定期随诊,随诊时间为14～110个月。其中,83例患者随诊期间肺内阴影没有明显变化;46例患者肺内阴影消失或缩小;6例(均为绒毛膜癌)患者在停药6～8个月后血β-hCG 水平升高,病情进展。152例肺内带瘤出院患者的病情进展率为3.9%(6/152),分别与901例 CR 患者的复发率[3.4%(31/901)]以及463例合并肺转移 CR 患者的复发率[2.2%(10/463)]比较,差异均无统计学意义(P>0.05)。结论妊娠滋养细胞肿瘤肺转移患者经规范治疗后血β-hCG 水平降至正常,再经过2～4个疗程的巩固化疗后其肺内阴影不再继续缩小或消失者,多为肺内转移灶坏死或局部纤维化,可以认为其为 CR。但出院后应密切随诊,尤其是停药6个月左右的绒毛膜癌患者。
Objective To analyze the prognosis of patients with lung metastasis of gestational trophoblastic tumor after standardized treatment, and to reduce the blood β-hCG level to normal. Methods From January 1985 to January 2004, Peking Union Medical College Hospital treated 1130 cases of gestational trophoblastic tumor patients, of which 901 patients received complete remission (CR) and 187 patients received partial remission (PR). Of the 901 patients with CR, 463 had pulmonary metastasis; 152 of 187 patients with PR had normal serum levels of β-hCG, but their lung metastases were not completely absorbed and their tumors were discharged. In this study, we retrospectively analyzed the clinical data of 152 patients with pulmonary intratumoral discharge who were compared with the prognosis of 901 patients with CR and 463 patients with pulmonary metastasis who were discharged at the same period. Results All 152 patients underwent standard multi-course multi-drug combination chemotherapy between 1 and 30 courses of treatment (3.6 courses on average), and their blood β-hCG levels dropped to normal. Then they received 0 to 8 courses of treatment (average 3.7 courses ) Consolidation chemotherapy and tumor discharge. Among the 152 patients with pulmonary tumor discharge, except the 17 patients who were not followed up, the remaining 135 patients were followed up regularly for 14 to 110 months. Among them, there was no significant change in the lung shadow of 83 patients during the follow-up period; 46 patients lost or contracted the lung shadow; 6 patients (all choriocarcinoma) had a decrease of blood β-hCG level after stopping 6-8 months High, the progress of the disease. The progression of disease in 152 patients with lung tumor was 3.9% (6/152), respectively, with the recurrence rate of 901 CR patients [3.4% (31/901)] and the recurrence rate of 463 CR patients with lung metastases [2.2% (10/463)], the difference was not statistically significant (P> 0.05). Conclusions The level of serum β-hCG in the patients with lung metastasis of gestational trophoblastic tumor after standard therapy has been reduced to normal. After 2 to 4 courses of chemotherapy, the intra-lung shadow no longer narrows or disappears, mostly lung metastasis Necrosis or local fibrosis, it can be considered as CR. However, after discharge should be closely followed, especially in about 6 months of chorion cancer patients.