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目的分析足月产后绒毛膜癌患者的临床特征、治疗和预后情况。方法回顾性分析了北京协和医院1985年12月至2005年6月间收治的103例足月产后绒毛膜癌患者的临床特征、治疗和预后情况。结果103例足月产后绒毛膜癌患者经过以化疗为主的综合治疗后,92例(89·3%)患者获得完全缓解,2例部分缓解,9例疾病进展死亡。92例完全缓解的患者中有4例复发,经过再次治疗3例完全缓解,1例死亡。103例患者中,25例出现耐药,经化疗或联合手术治疗后18例完全缓解,2例部分缓解,5例死亡。本组患者按2000年国际妇产科联盟(FIGO)标准,临床分期:Ⅰ期17例、Ⅱ期8例、Ⅲ期56例、Ⅳ期22例,各期的完全缓解率分别为100%、8/8、95%和64%,Ⅰ、Ⅱ、Ⅲ期的完全缓解率分别与Ⅳ期比较,差异均有统计学意义(P<0·05);预后评分:低危型(预后评分≤6分)35例,高危型(预后评分≥7分)68例,其完全缓解率分别为100%和84%,两者比较,差异有统计学意义(P<0·05)。结论提高足月产后绒毛膜癌的早期诊断率、采用联合化疗为主的多途径综合治疗、重视耐药和复发患者的治疗将明显提高足月产后绒毛膜癌的治愈率。
Objective To analyze the clinical features, treatment and prognosis of postoperative full-term choriocarcinoma patients. Methods The clinical features, treatment and prognosis of 103 full-term postoperative choriocarcinoma patients admitted to the Peking Union Medical College Hospital between December 1985 and June 2005 were retrospectively analyzed. Results After 103 full-term postmenopausal choriocarcinoma patients were treated with chemotherapy-based comprehensive therapy, 92 patients (89·3%) achieved complete remission, 2 patients partially resolved, and 9 patients died of disease progression. Of the 92 patients who achieved complete remission, 4 relapsed. After retreatment, 3 patients completed remission and 1 died. Of the 103 patients, 25 patients developed drug resistance. After chemotherapy or combined surgery, 18 patients achieved complete remission, 2 patients partially relieved, and 5 patients died. This group of patients according to the International Federation of Gynecology and Obstetrics (FIGO) 2000 criteria, clinical stage: 17 patients in phase I, 8 in phase II, 56 in phase III, and 22 in phase IV. The complete remission rate in each phase was 100%. 8/8, 95%, and 64%, complete remission rate of stage I, II, and III were significantly different from those of stage IV (P<0.05); prognosis scores were low-risk type (prognosis score ≤ 6 points) 35 cases, high-risk type (prognosis score ≥ 7 points) 68 cases, the complete remission rate was 100% and 84%, the difference was statistically significant (P <0. 05). Conclusions Increasing the rate of early diagnosis of postmenopausal choriocarcinoma, comprehensive treatment with multimodal approaches based on combination chemotherapy, and treatment with emphasis on drug resistance and relapse patients will significantly improve the cure rate of postmenopausal choriocarcinoma.