余慧;王伟红;熊莉莉;刘英;谷小雅;安瑞芳;

• 1:西安交通大学第一附属医院妇产科
• 2:西北妇女儿童医院

摘要(Abstract)：

目的:探讨40岁以上妊娠滋养细胞肿瘤(GTN)患者的临床特征、治疗方法及预后情况。方法:回顾分析2008年1月至2019年12月西安交通大学第一附属医院妇科收治的82例年龄≥40岁GTN患者的临床资料,用Kaplan-Meier法绘制无进展生存期(PFS),Cox风险比例回归模型进行PFS的单因素分析和多因素分析。结果:患者年龄40～58岁,中位年龄45.5岁,主要临床表现为阴道出血,误诊率高达19.51%,最终确诊侵蚀性葡萄胎51例[Ⅰ期26例,Ⅲ期25例,FIGO评分(4.73±2.48)分],绒毛膜癌31例[Ⅰ期12例,Ⅲ期16例,Ⅳ期3例,FIGO评分(10.1±4.90)分]。患者均根据评分接受化疗,共化疗422疗程,平均5.1疗程;56例患者接受化疗联合全子宫切除术。平均随访25.1月,7例复发,6例死亡,72例治愈,治愈率为87.80%。单因素Cox回归分析发现,年龄≥40岁GTN患者的预后危险因素有:产次>3次、发病距先期妊娠时间>18月、最大肿瘤直径≥5cm、脑转移、转移灶数目、先前化疗失败史、诊断为绒毛膜癌、FIGO评分≥7分。多因素Cox回归分析发现,年龄≥40岁GTN患者的预后危险因素是产次>3(HR=7.50,95%CI为1.33～42.16)和发病距先期妊娠时间>18月(HR=16.21,95%CI为3.39～77.45)。结论:年龄≥40岁妇女发生阴道出血时,应考虑与GTN鉴别,血β-HCG和盆腔B超有助于诊断。绒毛膜癌比侵蚀性葡萄胎发病距离先期妊娠时间长、β-HCG水平高、FIGO评分高、预后差。产次>3次和发病距先期妊娠时间>18月是影响年龄≥40岁GTN患者预后的独立危险因素。

关键词(KeyWords)： 妊娠滋养细胞肿瘤;40岁以上;化疗;全子宫切除术;无进展生存期

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金资助项目(No:81972428);; 西安交通大学第一附属医院院基金(No:2019QN-20)

作者(Authors): 余慧;王伟红;熊莉莉;刘英;谷小雅;安瑞芳;

DOI: 10.13283/j.cnki.xdfckjz.2021.07.031

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