本文選題：妊娠滋養(yǎng)細胞腫瘤　切入點：分期　出處：《北京協(xié)和醫(yī)學院》2017年博士論文　論文類型：學位論文

【摘要】：目的:探討1985-2015年在北京協(xié)和醫(yī)院婦產科滋養(yǎng)細胞疾病診治中心接受初始治療的妊娠滋養(yǎng)腫瘤(GTN)患者的療效,分析影響GTN患者預后的危險因素。方法:回顧性分析1985年1月至2015年12月間在北京協(xié)和醫(yī)院接受初始治療的妊娠滋養(yǎng)細胞腫瘤患者共1711例,其中1985-2001年545例,2002-2015年患者1166例。比較各年代不同診斷、分期及根據FIGO(2000)預后評分系統(tǒng)不同評分危險分層的患者的療效,并通過多因素COX回歸分析影響患者預后的危險因素及各因素的風險比(HR)。結果:1.總體1985-2015年我院初治GTN患者完全緩解(CR)率為96.3%(1648/1711例),1985-2001 年組 CR 率為 93.6%(510/545 例),2002-2015 年組為 97.6%(1138/1166 例),P0.001。2.總體初治GTN患者死亡率為2.57%(44/1711例),復發(fā)率為2.71%(45/1663例)。3.總體侵襲性葡萄胎(IM)患者CR率98.5%(1012/1027例),絨毛膜癌(CC)患者CR率93.0%(636/684例),CC患者的預后較IM患者差,HR=4.884(95%CI:2.735-8.721),P0.001,2002-2015 年組 IM 與 CC 的 CR 率均高于1985-2001 年組。4.總體I期患者511例(29.9%),II期患者57例(3.3%),III期患者1048例(61.3%),IV期患者95例(5.6%);2002-2015年組I期、II期、IV期患者比例均少于1985-2001年組,III期患者比例高于1985-2001年組;兩年代組IV期患者預后最差,但2002-2015 年組(76.5%)好于 1985-2001 年組(59.1%),P0.001。5.總體低危患者(0-6分)和高�；颊�(≥7分)的CR率分別為98.7%(1342/1359)和 86.9%(306/352),HR=11.092(95%CI:6.357-19.353),P0.001。6.FIGO(2000)的預后評分系統(tǒng)中年齡(是否≥40)、末次妊娠性質(葡萄胎或非葡萄胎)、轉移部位(是否有除肺以外的遠處轉移)是影響預后的獨立危險因素;而妊娠終止距化療開始時間、化療前hCG水平、腫瘤最大直徑、轉移數目雖單因素分析后結果有意義,但多因素分析結果顯示它們并不是影響預后的獨立危險因素。結論:GTN患者在經過及時規(guī)范的單/多藥化療后可以獲得十分滿意的療效,我院初治GTN患者的CR率近十余年來進一步提高。FIGO(2000)預后評分系統(tǒng)中有些因素或不是影響預后的獨立危險因素,尚需進一步修訂簡化。
[Abstract]:Objective: to investigate the effect of initial treatment on GTNN of gestational trophoblastic neoplasms (GTNN) in gynecology and obstetrics trophoblastic disease center of Peking Union Hospital from 1985 to 2015. Methods: 1 711 patients with gestational trophoblastic tumor who received initial treatment in Peking Union Hospital from January 1985 to December 2015 were analyzed retrospectively. Among them, 545 patients from 1985 to 2001 had 1166 patients from 2002 to 2015. The curative effect of patients with different diagnosis, stage and risk stratification according to Figo 2000 prognostic scoring system was compared. Multivariate COX regression analysis was used to analyze the risk factors affecting patients' prognosis and the risk of each factor. Results: 1: 1.The overall complete remission rate of GTN patients in our hospital from 1985 to 2015 was 96. 3% 1648 / 1711. From 1985 to 2001, the CR rate was 93.610 / 545 in 2002-2015 and 97.638 / 1166 in 2002-2015. The overall mortality rate of patients with GTN was 2.57 / 44 / 1711, and the recurrence rate was 2.71 / 45 / 1663. The CR rate of total invasive hydatidiform mole (IMI) patients was 98.555 / 1027, and the CR rate of patients with choriocarcinoma was 93.036 / 684. The prognosis of patients with CC was worse than that of IM patients. The CR rate was higher than that in 1985-2001 group .511 patients with stage I and 57 patients with stage II were 1048 patients with stage I and stage III, 95 patients with stage I and stage IV were lower than those with stage III in 1985-2001. The proportion of patients with stage III of stage I was lower than that of group III (1985-2001). The prognosis of stage IV patients in two years group was the worst. But 2002-2015 was better than 1985-2001 (P 0.001.5) and high-risk patients (鈮，

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