比较至少 40 岁的完全性葡萄胎妇女不同治疗策略：一项回顾性队列研究。

Comparison of different therapeutic strategies for complete hydatidiform mole in women at least 40 years old: a retrospective cohort study.

机构信息

Department of Gynaecology, Women's hospital, School of Medicine, Zhejiang University, No.1 Xueshi Road, Hangzhou, Zhejiang Province, China.

Department of Gynaecologic Oncology, Women's hospital, School of Medicine, Zhejiang University, No.1 Xueshi Road, Hangzhou, Zhejiang Province, China.

出版信息

BMC Cancer. 2017 Nov 9;17(1):733. doi: 10.1186/s12885-017-3749-8.

DOI:10.1186/s12885-017-3749-8

PMID:29121880

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5679144/

Abstract

BACKGROUND

There are three main therapeutic strategies, namely expectant management (dilation and curettage only), prophylactic chemotherapy and prophylactic total hysterectomy for treating older women with complete hydatidiform mole (CHM). However, the scientific community has so far, not unanimously accepted the above-mentioned methods. The objective of this study was to evaluate the effectiveness of these therapeutic strategies in preventing post-molar gestational trophoblastic neoplasia (GTN) pertaining to patients with CHM who were at least 40 years old.

METHODS

Hundred and seventy-one patients from our hospital who had histologically been diagnosed of CHM and underwent treatment from January 2004 to December 2013 were included. All patients were followed continuously for a minimum of 2 years after which relevant clinical data were extracted and analysed.

RESULTS

All patients were divided to three groups. Group 1 consisted of 124 patients, treated by expectant management, and the incidence of post-molar GTN was 37.1%. Group 2 included 12 patients who received prophylactic chemotherapy, with an incidence of 41.7%. The remaining 35 patients, Group 3, underwent prophylactic total hysterectomy, with the lowest incidence of 11.4%. A significantly lower incidence was noted in group 3 as compared to group 1 (P = 0.004). GTN patients who received prophylactic chemotherapy required, on average, longer time to be diagnosed of GTN and had higher probability of chemotherapy resistance (P = 0.031 and P = 0.024).

CONCLUSIONS

This retrospective analysis showed that prophylactic total hysterectomy was the most effective therapeutic strategy for treating CHM in women at least 40 years old of age.

摘要

背景

治疗年龄较大的完全性葡萄胎（CHM）患者有三种主要的治疗策略，即期待治疗（仅扩张和刮宫）、预防性化疗和预防性全子宫切除术。然而，医学界迄今尚未一致接受上述方法。本研究的目的是评估这些治疗策略在预防与年龄至少 40 岁的 CHM 患者相关的摩尔后滋养细胞肿瘤（GTN）方面的有效性。

方法

本研究纳入了 2004 年 1 月至 2013 年 12 月期间在我院经组织学诊断为 CHM 并接受治疗的 171 例患者。所有患者均至少连续随访 2 年，然后提取和分析相关临床数据。

结果

所有患者均分为三组。第 1 组包括 124 例接受期待治疗的患者，摩尔后 GTN 的发生率为 37.1%。第 2 组包括 12 例接受预防性化疗的患者，发病率为 41.7%。其余 35 例患者（第 3 组）接受预防性全子宫切除术，发病率最低，为 11.4%。第 3 组的发病率明显低于第 1 组（P=0.004）。接受预防性化疗的 GTN 患者平均需要更长的时间才能确诊为 GTN，并且发生化疗耐药的可能性更高（P=0.031 和 P=0.024）。