目的:为了阐明一组特殊的妊娠滋养细胞肿瘤(GTN)患者的临床病理特征和肿瘤结局,最初表现为孤立的肺部病变,人绒毛膜促性腺激素(hCG)水平升高,和未观察到的盆腔病变。
方法:总的来说,回顾性分析了2000年至2023年间在我们医院治疗的2358例GTN患者,对40例患者进行了评估。人口特征,临床病理特征,治疗数据,收集每位患者的随访资料。主要结果是无进展生存期。使用Kaplan-Meier分析以及单变量和多变量Cox比例风险分析来识别危险因素。
结果:在40名患者中,95.0%有单发肺部病变,中位数大小为1.9厘米。此外,72.5%的患者经病理证实为上皮样滋养细胞肿瘤(ETT)。在53.5个月的中位随访期内(范围,2-143),11例患者复发,包括所有单独接受化疗作为初始治疗的患者,没有观察到死亡。复发治疗包括肺段切除术和肺叶切除术结合化疗和免疫治疗。与手术±化疗相比,确定的单变量和多变量Cox分析,单独化疗作为初始治疗(风险比[HR]=7.738,95%置信区间[CI]1.698-35.269,P=0.008)作为复发的独立危险因素.
结论:有妊娠史的患者表现为孤立的肺部病变,HCG水平升高(大多<1000mIU/mL),和未观察到的骨盆病变,首先要考虑ETT。肺部病变的手术切除对于优化治疗至关重要。当考虑化疗时,建议使用多药方案。
OBJECTIVE: To elucidate the clinicopathological characteristics and oncological outcomes of a special group of patients with gestational trophoblastic neoplasia (GTN) initially presenting with isolated lung lesions, elevated human chorionic gonadotropin (hCG) levels, and unobserved pelvic lesions.
METHODS: Overall, 2358 patients with GTN treated at our hospital between 2000 and 2023 were retrospectively reviewed, and 40 patients were evaluated. The demographic characteristics, clinicopathological features, treatment data, and follow-up information of each patient were collected. The primary outcome was progression free survival. Kaplan-Meier analysis and univariate and multivariate Cox proportional hazard analyses were used to identify the risk factors.
RESULTS: Among the 40 patients, 95.0 % had solitary lung lesions, with a median size of 1.9 cm. Moreover, 72.5 % of patients were pathologically confirmed as epithelioid trophoblastic tumors (ETT). During a median follow-up period of 53.5 months (range, 2-143), 11 patients experienced recurrence, including all patients who received chemotherapy alone as the initial treatment, and no death was observed. Relapse treatment involved lung segmentectomy and lobectomy combined with chemotherapy and immunotherapy. Univariate and multivariate Cox analyses identified comparing with surgery±chemotherapy, chemotherapy alone as the initial treatment (hazard ratio [HR] =7.738, 95 % confidence interval [CI] 1.698-35.269, P = 0.008) as independent risk factor for recurrence.
CONCLUSIONS: In patients with a history of pregnancy exhibiting isolated pulmonary lesions, elevated hCG levels (mostly <1000 mIU/mL), and unobserved pelvic lesions, ETT should be considered first. Surgical resection of lung lesion is crucial for optimal management. When chemotherapy is considered, multidrug regimen is recommended.