Zhang Ying, Xiang Yang, Ren Tong, Wan Xi-run, Yang Xiu-yu
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2005 Feb;40(2):83-6.
To investigate the indication of lung lobectomy in patients of malignant trophoblastic tumor with lung metastasis.
Data on a total of 629 cases of malignant trophoblastic tumor of stage III-IV in Peking Union Medical College Hospital from 1990 to 2003 were reviewed. Ninety-five cases including those that underwent lung lobectomy and cases with normal level of serum human chorionic gonadotropin-beta subunit (beta-hCG, < 2 IU/L) and residual pulmonary nodules after chemotherapy were selected and studied.
Lung lobectomies were performed on six cases of invasive mole with lung metastasis and the pathological results were all necrotic nodules;another 35 cases of invasive mole with normal level of serum beta-hCG but residual pulmonary nodules after chemotherapy have been followed up for 6 months to 11 years and all were stable of diseases (SD). Lung lobectomies were performed on 29 cases of choriocarcinoma with lung metastasis. Among them, there were 17 cases whose pathological results were hemorrhage and necrotic tissue without trophoblastic cells (negative pathological results), while trophoblastic cells could still be detected in 12 cases of resected lung specimens (positive pathological results). Twenty-five cases of choriocarcinoma with normal serum beta-hCG but residual pulmonary nodules after chemotherapy were followed up, five cases had progress of disease (PD) and 20 were SD. There were no significant differences of age, stage and the last pregnancy between the positive and negative pathological results, SD and PD groups, respectively. However, the number of chemotherapeutic courses for decreasing beta-hCG from 10 IU/L to 2 IU/L and the total courses in the group of positive pathological results and PD group were significantly more than that of negative pathological results group and SD group (P = 0.01, P = 0.001).
For invasive mole, lung metastasis can be successfully treated by chemotherapy alone. Patients with residual pulmonary nodules but normal serum beta-hCG after chemotherapy can be followed up and spared lung lobectomy. For choriocarcinoma, slowly decreasing of beta-hCG from 10 IU/L to 2 IU/L is a high risk for chemoresistance, and it is an indication for thoracotomy. Progression of disease after multiple chemotherapy courses should be treated with lung lobectomy.
探讨肺叶切除术在恶性滋养细胞肿瘤肺转移患者中的应用指征。
回顾性分析1990年至2003年北京协和医院收治的629例Ⅲ - Ⅳ期恶性滋养细胞肿瘤患者的资料。选取95例患者，包括接受肺叶切除术的患者以及化疗后血清人绒毛膜促性腺激素β亚基（β - hCG，<2 IU/L）水平正常且肺部有残留结节的患者进行研究。
6例侵蚀性葡萄胎肺转移患者接受了肺叶切除术，病理结果均为坏死结节；另外35例侵蚀性葡萄胎患者血清β - hCG水平正常但化疗后肺部有残留结节，已随访6个月至11年，所有患者病情稳定（疾病稳定，SD）。29例绒毛膜癌肺转移患者接受了肺叶切除术。其中，17例病理结果为出血坏死组织，未见滋养细胞（病理结果阴性），而12例切除的肺标本中仍可检测到滋养细胞（病理结果阳性）。25例化疗后血清β - hCG水平正常但肺部有残留结节的绒毛膜癌患者进行了随访，5例病情进展（疾病进展，PD），20例病情稳定。病理结果阳性与阴性组、SD与PD组患者的年龄、分期及末次妊娠情况分别比较，差异均无统计学意义。然而，病理结果阳性组和PD组从β - hCG 10 IU/L降至2 IU/L所需的化疗疗程数及总疗程数均显著多于病理结果阴性组和SD组（P = 0.01，P = 0.001）。
对于侵蚀性葡萄胎，单纯化疗即可成功治疗肺转移。化疗后血清β - hCG水平正常但肺部有残留结节的患者可进行随访，无需行肺叶切除术。对于绒毛膜癌，β - hCG从10 IU/L缓慢降至2 IU/L提示化疗耐药风险高，是开胸手术的指征。多程化疗后病情进展者应行肺叶切除术。
