中国妇幼健康研究2025，Vol.36Issue(3)：85-93,9.DOI:10.3969/j.issn.1673-5293.2025.03.013
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
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分类
医药卫生引用本文复制引用
刘春琴,王伟红,薛艳,安瑞芳..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[J].中国妇幼健康研究,2025,36(3):85-93,9.基金项目
国家自然科学基金资助项目(81972428) （81972428）
陕西省自然科学基础研究资助项目(2021JM-282) （2021JM-282）
