| Objective:To investigate the clinical features,diagnosis,treatment and prognostic factors of gestational trophoblastic tumor,and to improve the clinical efficacy of gestational trophoblastic tumor.Methods:78 patients with gestational trophoblastic neoplasms admitted to the first affiliated Hospital of Kunming Medical University were collected from January 2010 to December 2016 and divided into invasive hydatidiform mole group and choriocarcinoma group.including 53 cases of invasive hydatidiform mole group and 25 cases of choriocarcinoma group.The general condition,clinical symptoms,extrauterine metastasis,surgical treatment,the effective rate and drug resistance rate of different chemotherapy regimens were analyzed retrospectively.The overall therapeutic effect was compared between the two groups.Results:1?Comparison of age distribution between the two groups:all the patients were between 17 and 51 years old,the average age was 29.65±8.99 years old,and the incidence rate of the patients aged 20 to 29 years was the highest(45.25%).There were 8 cases of invasive hydatidiform mole under 20 years old.There were no patients with choriocarcinoma in this age group.There was no significant difference between the two groups by continuous corrected x2 test(p>0.05).The incidence of choriocarcinoma group was higher than that of invasive hydatidiform mole group(20?29 years old,30?39 years Old,? 40 years old),but there was no significant difference between the two groups(p>0.05).2.The number of pregnancies was between 1 and 8,with an average number of pregnancies was 2.47±1.17 in the patients with GTN,and the incidence of Gtn increased with the increase of the number of pregnancies.The difference was statistically significant(p<0.05).3.The clinical manifestations of gestational trophoblastic tumor were irregular vaginal bleeding and asymptomatic increase of hCG in hydatidiform mole.There were 24 cases with invasive hydatidiform mole and 2 cases with choriocarcinoma in asymptomatic simple elevated blood hCG group.The incidence of invasive hydatidiform mole group was significantly higher than that of choriocarcinoma group.The difference between the two groups was statistically significant(p<0.05).There were 18 cases with irregular vaginal bleeding in invasive hydatidiform mole group and 14 cases in choriocarcinoma group.Although the incidence rate in choriocarcinoma group was higher than that in invasive hydatidiform mole group,there was no significant difference between the two groups(p>0.05).At the same time,the incidence of abdominal pain and hemoptysis were compared between the two groups.there was no significant difference between the two groups(p>0.05).4?Comparison of HCG value between the two groups:the hCG value of all patients was between 79.9-283000IU/L and the average hCG value was 33811.88±60845.30IU/Ll.Although the incidence of choriocarcinoma was slightly higher than that of invasive hydatidiform mole,the hCG values of the two groups were in<103IU/L?103?104IU/L?104?105IU/L and ? 105IU/L was no significant difference.between the two groups(p>0.05).5?There were 17 cases of pulmonary metastasis in invasive hydatidiform mole group,2 cases of other part metastasis,9 cases of lung metastasis in choriocarcinoma group and 2 cases of other part metastasis.There was no significant difference between the two groups(p>0.05).6?The total course of chemotherapy was 5.39 ± 2.44 times for invasive hydatidiform mole and 5.32±2.82 times for choriocarcinoma.The overall effective rate of MIX regimen was 44.44%,the drug resistance rate was 55.55%,In the low risk group,the effective rate of 5-FU and 5-FU+KSM regimen was 92.59%higher than that of MIX regimen,and the drug resistance rate was 42.85%lower than that of MTX regimen,the difference was statistically significant between the two groups(p<0.05).In the high risk group,the effective rate of chemotherapy with 5-FU or 5-FU+KSM regimen was 66.67%?70%,.The drug resistance rate was 33.33%?30%,respectively.There was no significant difference between the two groups(p>0.05).7?Comparison of the operation conditions between the two groups:6 cases of invasive hydatidiform mole group needed surgical treatment,6 cases of choriocarcinoma group needed surgical treatment,the difference was not statistically significant.There were 7 cases of gestational trophoblastic tumor aged ? 40 years treated with operation and 8 cases of gestational trophoblastic tumor untreated with operation,the difference was statistically significant(p<0.05),that is,the probability of surgical treatment was higher in patients with gestational trophoblastic tumor40 years old.8?Univariate analysis showed that the rate of initial drug resistance in gestational trophoblastic tumor patients was significantly higher than 40 years old,the focus5 cm,the peak value of hCG? 104 IU/L before treatment,and the prognosis score?5 point.The difference was statistically significant,but it was associated with the number of miscarriages.There was no significant difference in the nature of previous pregnancy?figo score?anatomical staging of patients with ?-??choriocarcinoma patients(p>0.05).The multivariate logistic regression analysis showed that age ? 40 years old was the most important factor of initial drug resistance(p<0.05).9?The total curative rate of invasive hydatidiform mole group was 100%and the cure rate of choriocarcinoma group was 92%.The difference was statistically significant(p<0.05).Conclusion:1?Gestational trophoblastic neoplasms are more common in women of childbearing age;the incidence of IHM and CC was not related to the age group.But the incidence of choriocarcinoma in patients with pregnancy ? 4 times is increased.2?The clinical manifestations of gestational trophoblastic tumor were usually irregular vaginal bleeding and elevated asymptomatic blood hcg in hydatidiform mole after uterus removal.3?The incidence of invasive hydatidiform mole and choriocarcinoma was not correlated with the level of hCG values at first admission.4?Both IHM and CC patients are more likely to metastasize,especially in the lung metastasize.5?The treatment of gestational trophoblastic neoplasms was still mainly chemotherapy.The effective rate of MTX regimen was lower than that of 5-FU and 5-FU+KSM regimen,and the drug resistance rate was higher than that of 5-FUand 5-FU+KSM regimen.At the same time,surgery is still an important adjuvant therapy for gestational trophoblastic tumor with local metastasis?drug resistance and recrudescence.6?There was no significant difference between invasive hydatidiform mole group and choriocarcinoma group in surgical treatment,but the patients with gestational trophoblastic tumor were more likely to receive surgical treatment than 40 years old.7?The factors related to drug resistance are age>40 years old,lesion size>5 cm,HCG peak value ? 104IU/L before treatment and figo score>5 points.However,there was no correlation between drug resistance and choriocarcinoma patients,the number of miscarriages,the previous pregnancy as hydatidiform mole,and the anatomic stage of ?-?.8?The overall therapeutic effect of invasive hydatidiform mole was better than that of choriocarcinoma. |
PDF Full Text Request