Effectiveness of craniotomy and long-term survival in 35 patients with gestational trophoblastic neoplasia with brain metastases: a clinical retrospective analysis.
Effectiveness of craniotomy and long-term survival in 35 patients with gestational trophoblastic neoplasia with brain metastases: a clinical retrospective analysis.
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DOI：
10.3802/jgo.2022.33.e33
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发表时间：
2022-05
影响因子：
3.9
通讯作者：
Xiang, Yang
中科院分区：
文献类型：
--
作者：
Li, Yuan;Wang, Weidi;Wan, Xirun;Feng, Fengzhi;He, Yong-Lan;Yang, Junjun;Xiang, Yang
探讨妊娠滋养细胞瘤（GTN）脑转移开颅手术患者的临床特点、治疗方法和预后因素。使用GTN数据库确定了1990年1月至2018年12月期间在北京协和医院发生脑转移并随后接受开颅手术的35例GTN患者。回顾性分析其临床表现、治疗方法、转归及影响预后的因素。所有35名患者均接受了去骨瓣减压术、血肿清除术和转移性肿瘤切除术联合多药化疗。80%（28/35）获得完全缓解，11.4%（4/35）获得部分缓解，8.6%（3/35）出现疾病进展。不计2例失访患者，81.8%的患者（27/33）在中位随访72个月后存活。5年总生存率为80.4%。单因素分析显示，化疗失败史（p=0.020）和开颅手术和化疗开始之间的间隔>1周（p=0.027）是生存的不良风险因素。多变量分析显示，既往化疗失败仍然是生存不良的独立危险因素（比值比=11.50; 95%置信区间=1.55-85.15; p=0.017）。如果有脑转移的GTN患者存在转移性出血和颅内高压导致脑疝风险，则去骨瓣减压术是挽救生命的选择。通过围手术期多学科协作和术后及时规范化疗，可提高生存率，改善预后。对于有脑疝风险的GTN患者，去骨瓣减压术是一种挽救生命的选择。开颅手术结合及时的标准化疗有助于提高某些患者的生存率。既往化疗失败是生存不良的独立危险因素。
To investigate the clinical characteristics, treatments, and prognostic factors among patients with gestational trophoblastic neoplasia (GTN) exhibiting brain metastases who underwent craniotomy. Thirty-five patients with GTN who had brain metastases and subsequently underwent craniotomies between January 1990 and December 2018 at Peking Union Medical College Hospital were identified using the GTN database. Their clinical manifestations, treatments, outcomes, and prognostic factors were retrospectively analyzed. All 35 patients underwent decompressive craniotomy, hematoma removal, and metastatic tumor resection combined with multiagent chemotherapy. Eighty percent (28/35) achieved complete remission, 11.4% (4/35) achieved partial remission, and 8.6% (3/35) had progressive disease. Not counting 2 patients who were lost to follow-up, 81.8% of the patients (27/33) were alive after a median follow-up of 72 months. The 5-year overall survival rate was 80.4%. Univariate analysis revealed that a history of chemotherapy failure (p=0.020) and a >1-week interval between craniotomy and chemotherapy commencement (p=0.027) were adverse risk factors for survival. Multivariate analysis showed that previous chemotherapy failure remained an independent risk factor for poor survival (odds ratio=11.50; 95% confidence interval=1.55–85.15; p=0.017). Decompressive craniotomy is a life-saving option if metastatic hemorrhage and intracranial hypertension produce a risk of cerebral hernia in patients with GTN who have brain metastases. Higher survival rates and improved prognoses can be achieved through perioperative multidisciplinary cooperation and timely standard postoperative chemotherapy. Decompressive craniotomy is a life-saving option for patients with GTN at risk of cerebral hernia. Craniotomy combined with timely standard chemotherapy could help improve survival in certain patients. Previous chemotherapy failure is an independent risk factor for poor survival.
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影响因子：
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作者：
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通讯作者：
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DOI：
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