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目的 评价手术联合化疗治疗耐药性妊娠滋养细胞肿瘤(GTN)患者的疗效,并进一步探讨预测其疗效的因素.方法 回顾性分析1996年1月至2006年1月间,在北京协和医院接受手术联合化疗治疗的42例耐药性GTN患者的术前临床特征及治疗情况、术后病理检查结果 及最终治疗结局.结果 42例耐药性GTN患者在停止化疗时,血清学完全缓解32例(占76%),治疗无效10例,血清学完全缓解后的复发率为13%(4/32).预测疗效的单因素分析显示,有生殖道和肺脏以外的转移、末次妊娠性质为非葡萄胎的患者更可能出现治疗无效[其治疗无效的百分率分别为50%(5/10)、100%(10/10),P=0.023、0.017];末次术前血人绒毛膜促性腺激素β亚单位(β-hCG)>10 U/L和术前治疗期间血β-hCG水平从未正常过的患者也更易出现治疗无效[其治疗无效的百分率分别为60%(6/10)、90%(9/10),P=0.020、0.003].若以<35岁患者发生治疗无效的OR值为1,则≥35岁患者发生治疗无效的OR值为12.6(95%CI为2.4～66.0,P=0.002);以末次术前化疗方案的种类<4种的患者发生治疗无效的OR值为1,则化疗方案的种类≥4种的患者发生治疗无效的OR值为4.5(95%CI为1.0～20.1,P=0.059).10例治疗无效的患者均具有≥3项的上述治疗无效预测因素.结论 手术联合化疗治疗耐药性GTN患者可以获得较满意的疗效.但具有年龄≥35岁、末次妊娠性质为非葡萄胎、有生殖道和肺脏以外的转移、术前血β-hCG>10 U/L、术前治疗期间血β-hCG水平从未正常过、术前化疗方案的种类≥4种的6项因素中任何3项及3项以上的患者,通常预示疗效不良,对这些患者应谨慎选择联合手术治疗.

Objective To evaluate the efficacy of surgical management combined with chemotherapy in the treatment of drug-resistant gestational trophoblastic neoplasm(GTN)patients,and investigate factors influencing the outcome of the surgery combined with chemotherapy.Methods Medical records of 42 patents with drug-resistant GTN who were treated by chemotherapy combined with surgical management at Peking Union Medical College Hospital from Jan 1996 to Jan 2006 were reviewed.Results Among 42 patients,32 achieved serologically complete rendssion(SCR)with an SCR rate of 76%,and 10 patients had a treatment failure.Treatment failure was more frequently geen in patients who also had metastasis of other sites except for lungs and vagina and patients with antecedent non-molar pregnancy (P=0.023 and 0.017,respectively).Preoperative human chorionie gonadotropin-beta subunit(β-hCG)titer>10 U/L (P=0.020),failure to reach normal serum titers of β-hCG during treatment(P=0.003),age ≥35 years (OR:12.6,95%CI:2.4-66.0,P=0.002)and preoperative chemotherapy regimens≥4(OR:4.5,95% CI:1.0-20.1.P=0.059)were also correlated with treatment failure.All the 10 patients with treatment failure had at least 3 of 6 above mentioned predictors of treatment failure.Conclusions Surgical management combined with chemotherapy is effective in the treatment of drug-resistant GTN.Age≥35 years,antecedent non-molar pregnancy,metastasis of other sites except for lungs and vagina,preoperative β-hCG titer>10 U/L,failure to reach normal serum titers of β-hCG during treatment,and preoperative chemotherapy regimens≥4 are significant predictors of treatment failure.Patients with 3 or more predictors of treatment failure usually have poor prognosis.Therefore,surgical management should not be performed for these patients.