■生殖细胞肿瘤(GCT)代表高度可治愈的癌症。然而,一小部分低风险患者可发展为与急性呼吸窘迫综合征(ARDS)相关的绒毛膜癌综合征(CS),死亡率高.我们的回顾性研究旨在确定易患CS发展的低风险GCT的危险因素。
■使用计算机化的数据库和系统的图表审查,我们确定了2000年至2018年在美国国家癌症研究所接受GCT治疗的532例患者的记录.根据IGCCCG分类,确定了90名具有低风险GCT的合格患者。所有患者均接受以铂类为基础的诱导化疗。收集临床病理变量并分析与CS发展的相关性。
■90例患者中有9例(10%)在化疗后1天(1-9天)出现CS。由于发生ARDS,所有患者在化疗开始后不久死亡,中位时间为4天(3-35天)。在单变量分析中,转移性肺受累≥50%的肺实质,组织学标本中的绒毛膜癌成分,呼吸困难,咳嗽,咯血,ECOGPS≥2,体重减轻,血红蛋白≤100g/l,报告时NLR≥3.3与CS发展相关。在多变量分析中,ECOGPS≥2和转移性肺受累≥50%与CS独立相关。所有具有这两个特征的患者都发展为CS,与0或其中一个因素的0%相比(p<0.000001)。
■在我们的研究中,我们确定了与CS发展相关的因素。这些因素可能会改善CS易感患者的风险分层并改善其预后。
UNASSIGNED: Germ cell tumors (GCTs) represent a highly curable cancer. However, a small proportion of poor-risk patients can develop choriocarcinoma syndrome (CS) connected with acute respiratory distress syndrome (ARDS) with a high mortality rate. Our retrospective study aimed to determine the risk factors of poor-risk GCTs susceptible to CS development.
UNASSIGNED: Using a computerized database and a systematic chart review, we identified the records of 532 patients with GCTs treated at the National Cancer Institute from 2000 to 2018. Ninety eligible patients with poor-risk GCTs based on IGCCCG classification were identified. All patients were treated with platinum-based induction chemotherapy. Clinicopathological variables were collected and analyzed in correlation with CS development.
UNASSIGNED: Nine (10%) of 90 patients developed CS in a median of 1 day (1-9 days) after chemotherapy administration. All patients died shortly after the chemotherapy start with a median of 4 days (3-35 days) due to ARDS development. In univariate analysis, metastatic lung involvement ≥50% of lung parenchyma, choriocarcinoma elements in histology specimen, dyspnea, cough, hemoptysis, ECOG PS ≥2, weight loss, hemoglobin ≤100 g/l, and NLR ≥3.3 at the time of presentation were associated with CS development. In multivariate analysis, ECOG PS ≥2 and metastatic lung involvement ≥50% were independently associated with CS. All patients with these two characteristics developed CS, compared to 0% with zero or one of these factors (p < 0.000001).
UNASSIGNED: In our study, we identified factors associated with CS development. These factors might improve the risk stratification of the patients susceptible to CS and improve their outcome.