Fatal gestational trophoblastic neoplasia: An analysis of treatment failures at the Brewer Trophoblastic Disease Center from 1979-2012 compared to 1962-1978
Fatal gestational trophoblastic neoplasia: An analysis of treatment failures at the Brewer Trophoblastic Disease Center from 1979-2012 compared to 1962-1978
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DOI：
10.1016/j.ygyno.2015.05.041
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发表时间：
2015-08-01
影响因子：
4.7
通讯作者：
Lurain, John R.
中科院分区：
文献类型：
--
作者：
Neubauer, Nikki L.;Strohl, Anna E.;Lurain, John R.
Objective.比较1979-2012年与1962- 1978年Brewer滋养细胞疾病中心妊娠滋养细胞肿瘤（GTN）死亡的临床因素。回顾性地确定了1979-2012年死于GTN的19名女性，并与1962-1978年死于GTN的45名女性进行了比较。分析的临床因素包括人口统计学、治疗前人绒毛膜促性腺激素（hCG）水平、病程、既往妊娠、转移灶的数量和部位、FIGO分期和评分、治疗和死亡原因。1979-2012年治疗的483例患者中有19例（4%）发生GTN死亡，而1962-1978年治疗的396例患者中有45例（11%）发生GTN死亡（P < 0.001）。治疗前hCG水平> 100，000 mIU/mL，从妊娠事件到治疗的时间> 4个月，非磨牙前期妊娠和使用手术控制转移性疾病在两个治疗时期之间相似。与早期系列相比，最近系列中的患者更有可能出现FIGO IV疾病或脑转移，最初接受多药化疗，并在转诊到我们中心之前接受治疗。1979-2012年和1962-1978年最常见的死亡原因分别是一个或多个转移部位出血（11% vs. 42%）、呼吸衰竭（37% vs. 31%）和广泛耐药疾病导致的多器官衰竭（42% vs. 8%）。我们的妊娠滋养细胞肿瘤患者的总生存率从1962-1978年的89%提高到1979-2012年的96%。在1979-2012年间，更多的患者死于广泛的化疗耐药疾病，而不是出血性并发症。(C)2015 Elsevier Inc. All rights reserved.
Objective. To determine clinical factors that contributed to death from gestational trophoblastic neoplasia (GTN) at the Brewer Trophoblastic Disease Center from 1979-2012 compared to 1962-1978.Methods. Nineteen women who died of GTN from 1979-2012 were retrospectively identified and compared to 45 women previously reported on who died of GTN from 1962-1978. Clinical factors analyzed included demographics, pretreatment human chorionic gonadotropin (hCG) level, duration of disease, antecedent pregnancy, number and sites of metastases, FIGO stage and score, treatment, and cause of death.Results. Death from GTN occurred in 19(4%) of 483 patients treated from 1979-2012 compared to 45(11%) of 396 patients treated from 1962-1978 (P < 0.001). Pretreatment hCG level > 100,000 mIU/mL, time from pregnancy event to treatment > 4 months, nonmolar antecedent pregnancy and use of surgery to control metastatic disease were similar between the two treatment eras. Patients in the recent series were more likely to have presented with FIGO IV disease or brain metastasis, been initially treated with multiagent chemotherapy, and received treatment before referral to our center compared to the earlier series. The most common causes of death from 1979-2012 and 1962-1978 were hemorrhage from one or more metastatic sites (11% vs. 42%), respiratory failure (37% vs. 31%), and multiorgan failure due to widespread chemoresistant disease (42% vs. 8%), respectively.Conclusions. Our overall survival rate in patients with gestational trophoblastic neoplasia improved from 89% in 1962-1978 to 96% in 1979-2012. More patients treated between 1979-2012 died from widespread chemoresistant disease rather than hemorrhagic complications. (C) 2015 Elsevier Inc. All rights reserved.