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胎盘部位滋养细胞肿瘤的25年临床经验

Twenty-five years' clinical experience with placental site trophoblastic tumors.

作者信息

Papadopoulos Andreas J, Foskett Marianne, Seckl Michael J, McNeish Iain, Paradinas Fernando J, Rees Helen, Newlands Edward S

机构信息

Department of Gynaecological Oncology, Guys & St Thomas's National Health Service Trust, and Departments of Medical Oncology and Histopathology, Charing Cross Hospital, London, U.K.

出版信息

J Reprod Med. 2002 Jun;47(6):460-4.

Abstract

OBJECTIVE

To describe 34 cases of placental site trophoblastic tumor (PSTT) treated at Charing Cross Hospital over 25 years.

STUDY DESIGN

Between 1975 and 2001, 1,685 patients with gestational trophoblastic disease (GTD) were treated; 34 of them had PSTT (2%). The computer database clinical notes and the pathology reports were accessed to obtain data on this patient group. The data were subsequently analyzed using Excel computer software.

RESULTS

The mean age of the group was 33 years (95% CI 25-41). The antecedent pregnancy was a full-term, normal one in 18 cases (53%), a molar pregnancy in 7 (21%) and a missed abortion in 5 (15%). The mean interval from the last pregnancy to diagnosis was 3.4 years (95% CI 1.9-4.9). The range of serum hCG concentrations at diagnosis was 0-58,000, 79% with levels < 1,000 and 58% < 500. hCG was raised in all with active disease. The most frequent presenting complaint was vaginal bleeding, in 27 cases (79%). At diagnosis, the disease was localized to the uterus in 15 (44%); there was pelvic involvement in 8 (24%) and lung secondaries in 10 (29%). All seven deaths were disease related (21%); all had lung secondaries and presented more than four years since the last pregnancy. Excluding the seven deaths, the primary treatment was surgery alone in 10 cases (37%) (8 hysterectomies and 2 dilatation and curettages); 4 had surgery followed by adjuvant chemotherapy; 5 had neoadjuvant chemotherapy followed by surgery; 1 had chemotherapy alone, and the disease recurred and was successfully rechallenged; and 5 had surgery between chemotherapy cycles. The most common regimens consisted of EMA/CO and EP/EMA.

CONCLUSION

Risk factors for death include lung metastatic involvement (50%) and an antecedent pregnancy interval of four years or more (100%). In contrast, those with no extrapelvic disease or a pregnancy interval of less than four years had 100% survival. In two-thirds of patients with disease limited to the uterus, surgery alone was curative. The WHO scoring system for GTD did not correlate with this outcome. Patients with PSTT should be managed separately from those with other types of GTD, as the disease behavior is different.

摘要

目的

描述在查令十字医院25年间治疗的34例胎盘部位滋养细胞肿瘤(PSTT)。

研究设计

1975年至2001年间,对1685例妊娠滋养细胞疾病(GTD)患者进行了治疗;其中34例为PSTT(2%)。通过计算机数据库临床记录和病理报告获取该患者组的数据。随后使用Excel计算机软件对数据进行分析。

结果

该组患者的平均年龄为33岁(95%可信区间25 - 41岁)。前次妊娠为足月正常妊娠的有18例(53%),葡萄胎妊娠7例(21%),稽留流产5例(15%)。从末次妊娠到诊断的平均间隔时间为3.4年(95%可信区间1.9 - 4.9年)。诊断时血清hCG浓度范围为0 - 58,000,79%的患者hCG水平<1,000,58%<500。所有有活动性疾病的患者hCG均升高。最常见的主诉是阴道出血,27例(79%)。诊断时,疾病局限于子宫的有15例(44%);盆腔受累8例(24%),肺转移10例(29%)。7例死亡均与疾病相关(21%);均有肺转移,且自末次妊娠后发病超过4年。排除7例死亡病例,10例(37%)的主要治疗为单纯手术(8例子宫切除术和2例刮宫术);4例先手术,后辅助化疗;5例先新辅助化疗,后手术;1例单纯化疗,疾病复发后再次化疗成功;5例在化疗周期之间进行手术。最常用的方案包括EMA/CO和EP/EMA。

结论

死亡风险因素包括肺转移(50%)和前次妊娠间隔4年或更长时间(100%)。相比之下,无盆腔外疾病或妊娠间隔少于4年的患者生存率为100%。在三分之二疾病局限于子宫的患者中,单纯手术可治愈。WHO的GTD评分系统与该结果无关。PSTT患者应与其他类型的GTD患者分开管理,因为其疾病行为不同。

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