摘要目的 探讨预防性化疗对40岁以上侵蚀性葡萄胎患者治疗结局及预后的影响.方法 回顾性分析2005年1月至2015年6月中国医学科学院北京协和医学院北京协和医院收治的40岁以上侵蚀性葡萄胎患者共115例.其中,11例在确诊侵蚀性葡萄胎前接受过预防性化疗(预防性化疗组),104例在确诊侵蚀性葡萄胎后开始治疗性化疗(非预防性化疗组),比较两组患者的一般临床资料[包括年龄、临床分期、预后评分(按国际妇产科联盟2000年的评分标准)]、治疗方案、治疗结局及复发情况等.结果 (1)一般临床资料:预防性化疗组、非预防性化疗组患者的年龄分别为(47±5)、(46±4)岁;临床分期Ⅰ～Ⅱ期者分别占3/11、29.8％(31/104),Ⅲ～Ⅳ期者分别占8/11、70.2％(73/104);预后评分0～6分者分别占11/11、84.6％ (88/104),＞6分者分别占0、15.4％(16/104).两组患者年龄、临床分期、预后评分分别比较,差异均无统计学意义(P＞0.05).(2)治疗方案:预防性化疗组与非预防性化疗组患者的总化疗疗程数(中位数分别为7、5个)比较,差异有统计学意义(Z=3.071,P=0.002);而两组患者的治疗性化疗开始至血清β-hCG水平降至正常所需疗程数、巩固化疗疗程数、总治疗性化疗疗程数、子宫切除率分别比较,差异均无统计学意义(P＞0.05).(3)治疗结局及复发情况:预防性化疗组、非预防性化疗组患者的完全缓解率分别为11/11、98.1％ (102/104),复发率分别为0、1.0％(1/102),两组患者完全缓解率、复发率分别比较,差异均无统计学意义(P＞0.05).结论 40岁以上侵蚀性葡萄胎患者未从预防性化疗中明显获益,预防性化疗可能不能明显改善其预后,有待扩大样本量进一步研究.

abstractsObjective To discuss the effects of prophylactic chemotherapy on the outcomes and prognosis of invasive mole patients.Methods One hundred and fifteen invasive mole (IM) patients older than 40 years were registered in Peking Union Medical Collage Hospital.Eleven of them were treated with prophylactic chemotherapy before diagnosed as IM prophylactic chemotherapy group,while the other 104 cases received therapeutic chemotherapy after diagnosed as IM (non-prophylactic chemotherapy group).The general clinical data (including age,clinical stage,risk factor score),treatment,outcomes and relapse of patients were retrospectively compared between two groups.Results (1) The age of prophylactic chemotherapy group and non-prophylactic chemotherapy group were (47±5) versus (46±4) years old.Ratio of clinical stage Ⅰ-Ⅱ were 3/11 versus 29.8％ (31/104),clinical stage Ⅲ-Ⅳ were 8/11 versus 70.2％ (73/104).Ratio of risk factor score 0-6 were 11/11 versus 84.6％ (88/104),risk factor score ＞6 were 0 versus 15.4％(16/104).There were no significant statistical differences between two groups in age,clinical stage or risk factor score (all P＞0.05).(2) Treatment:the total chemotherapy courses between prophylactic chemotherapy group and non-prophylactic chemotherapy group (median 7 versus 5) were significantly different (Z=3.071,P=0.002).There were no significant statistical differences between two groups in the chemotherapy courses until negative conversion of β-hCG,consolidation chemotherapy courses,total therapeutic chemotherapy courses or ratio of hysterectomy (all P＞0.05).(3) Outcomes and relapse:between the prophylactic chemotherapy group and the non-prophylactic chemotherapy group,the complete remission rate were 11/11 versus 98.1％(102/104),the relapse rate were 0 versus 1.0％(1/102).There were no significant difference between the two groups in outcomes or relapse rate (P＞0.05).Conclusions Prophylactic chemotherapy does not substantially benefit the IM patients older than 40 years.Prophylactic chemotherapy may not significantly improve patients' prognosis,in which increased sample size is required in further study.