University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, Department of Gynecological Surgery and Oncology, Obstetrics, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France.
University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, Department of Gynecological Surgery and Oncology, Obstetrics, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France.
J Gynecol Obstet Hum Reprod. 2023 Oct;52(8):102636. doi: 10.1016/j.jogoh.2023.102636. Epub 2023 Jul 25.
Liver metastases of gestational trophoblastic neoplasia (GTN) are rare, but associated with poor prognosis. The additional concomitant presence of brain or intra-abdominal metastases, with liver metastases has been described as worsening factors, but the literature on this topic is reduced.
To estimate the overall mortality, specific hepatic morbidity, and mortality, and to identify prognostic factors for patients with GTN and liver metastases.
The medical records of 26 GTN patients with liver metastases registered in the French Center for Trophoblastic Diseases and treated between November 1999 and December 2019 were reviewed. Overall survival was described using Kaplan-Meier estimates. Prognostic factors were identified using univariate and multivariate Cox analyses.
The 5-year overall survival rate was 60.7% for all patients with liver metastasis. The survival rate was higher in patients who achieved complete remission after first-line chemotherapy than in those who did not (100% vs 20%, p = 0.001). The only factor independently associated with prognosis was the presence of 6 or more liver metastases (5-year survival, 16.7% vs. 82.4% otherwise; HR =11.1, 95%CI, 2.3-53.1; p = 0.003). None of the five patients with a single liver metastasis died.
GTN with liver metastasis is very rare (1.6%). The prognosis of patients seems to be improving. The results of this study are also reassuring for patients with complete remission after first-line combination chemotherapy, as well as for those with a single liver metastasis.
妊娠滋养细胞肿瘤（GTN）肝转移较为罕见，但预后较差。伴有脑转移或腹腔内转移的同时存在肝转移被描述为恶化因素，但关于这一主题的文献较少。
评估 GTN 伴肝转移患者的总体死亡率、肝脏特定发病率和死亡率，并确定其预后因素。
回顾了 1999 年 11 月至 2019 年 12 月期间在法国滋养细胞疾病中心登记的 26 例 GTN 伴肝转移患者的病历。采用 Kaplan-Meier 估计法描述总生存率。采用单因素和多因素 Cox 分析确定预后因素。
所有肝转移患者的 5 年总生存率为 60.7%。一线化疗后达到完全缓解的患者生存率高于未达到完全缓解的患者（100% vs. 20%，p=0.001）。唯一与预后相关的独立因素是存在 6 个或更多的肝转移（5 年生存率，16.7% vs. 82.4%；HR=11.1，95%CI，2.3-53.1；p=0.003）。无单发肝转移的患者死亡。
GTN 伴肝转移非常罕见（1.6%）。患者的预后似乎在改善。对于一线联合化疗后完全缓解的患者以及单发肝转移的患者，本研究的结果也令人安心。
