Sun Yin, Xiang Yang, Wan Xi-run, Yang Xiu-yu
Department of Obstetrics and Gynecology, College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Zhonghua Fu Chan Ke Za Zhi. 2006 May;41(5):329-32.
To analyse the factors associated with recurrence of choriocarcinoma and to evaluate the treatment outcomes of choriocarcinoma.
The records of 490 patients with choriocarcinoma treated at Peking Union Medical College Hospital (PUMCH) were reviewed and evaluated for recurrent episodes of choriocarcinoma.
Three hundred and ninety-four women achieved primary remission; 17 (4.3%) developed one or more episodes of recurrent choriocarcinoma. Recurrent rate in low-risk patients was 2.4% (5/208), while in high-risk patients 6.5% (12/186). Recurrent rates among those without and with 1 course of maintenance chemotherapy patients were 6.1% (3/49) and 9.8% (6/61) respectively, while in 2, 3, and >3 courses of maintenance therapy patients were 1.4% (1/70), 3.9% (2/51) and 3.1% (5/163) respectively. Thirteen (76.5%, 13/17) patients with recurrent choriocarcinoma recurred within 3 years and 4 patients after 3 years. Sixteen (94.1%) of 17 patients achieved secondary remission; 6 (37.5%) of 16 developed a second recurrence, and one was lost to follow-up after partial remission. In addition, 21 patients were referred to PUMCH from other hospitals for salvage therapy at the time of recurrence. Totally 38 patients of recurrent choriocarcinoma were treated at our hospital; 29 recurred once, 7 recurred twice and 2 recurred 4 times. There were totally 51 instances treated for recurrent choriocarcinoma. The complete remission rates in patients using chemotherapy only was 69.2% (18/26), the second recurrent rates of these patients was 50.0% (9/18); the complete remission rates in patients using chemotherapy combined with surgery was 92.0% (23/25), the second recurrent rates of these patients was 17.4% (4/23).
Factors related to development of recurrent choriocarcinoma include high-risk at initial evaluation and less than two courses of maintenance chemotherapy beyond the primary remission. Most patients of recurrent choriocarcinoma recur within 3 years; the recurrent choriocarcinoma is of poor prognosis and should be treated aggressively. Chemotherapy combined with surgery is the most important method to increase cure rates and to decrease recurrent rates.
分析与绒毛膜癌复发相关的因素，并评估绒毛膜癌的治疗效果。
回顾并评估北京协和医院收治的490例绒毛膜癌患者的病历，以了解绒毛膜癌的复发情况。
394例女性患者达到初次缓解；17例（4.3%）出现一次或多次绒毛膜癌复发。低危患者的复发率为2.4%（5/208），高危患者为6.5%（12/186）。未接受和接受1个疗程维持化疗患者的复发率分别为6.1%（3/49）和9.8%（6/61），而接受2个、3个及超过3个疗程维持化疗患者的复发率分别为1.4%（1/70）、3.9%（2/51）和3.1%（5/163）。13例（76.5%，13/17）绒毛膜癌复发患者在3年内复发，4例在3年后复发。17例患者中有16例（94.1%）达到二次缓解；16例中的6例（37.5%）出现第二次复发，1例在部分缓解后失访。此外，21例患者在复发时从其他医院转至北京协和医院接受挽救治疗。我院共治疗38例绒毛膜癌复发患者；29例复发1次，7例复发2次，2例复发4次。绒毛膜癌复发患者共接受51次治疗。单纯化疗患者的完全缓解率为69.2%（18/26），这些患者的第二次复发率为50.0%（9/18）；化疗联合手术患者的完全缓解率为92.0%（23/25），这些患者的第二次复发率为17.4%（4/23）。
与绒毛膜癌复发相关的因素包括初次评估时为高危以及初次缓解后维持化疗疗程少于两个。大多数绒毛膜癌复发患者在3年内复发；绒毛膜癌复发预后较差，应积极治疗。化疗联合手术是提高治愈率和降低复发率的最重要方法。
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