Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital.
Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking union medical college hospital.
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妊娠滋养细胞肿瘤脑转移患者的治疗及预后：北京协和医院24年经验
DOI：
10.1186/s12885-015-1325-7
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发表时间：
2015-04-28
期刊：
影响因子：
3.8
通讯作者：
Xiang Y
中科院分区：
文献类型：
--
作者：
Xiao C;Yang J;Zhao J;Ren T;Feng F;Wan X;Xiang Y
背景妊娠滋养细胞瘤（GTN）脑转移患者的最佳治疗方法尚未确定。本研究旨在探讨GTN脑转移的临床特点和处理与患者预后的关系。方法回顾性分析1990年1月至2013年12月北京协和医院收治的109例GTN脑转移患者。患者主要接受氟脲嘧啶或氟尿定、放线菌素、依托泊苷、长春新碱（FAEV）联合鞘内甲氨蝶呤多药化疗，伴或不伴手术。结果109例患者中，62例（56.1%）接受了首次化疗，47例在其他地方化疗失败。8例在化疗前或第一周期中死亡的早期死亡患者被排除在分析之外。中位随访时间为47个月（范围9-180个月）。总5年生存率（OS）为71.1%，而在我院接受原发性化疗的患者的OS为85.5%，而在其他地方接受多药化疗失败的患者的OS为51.9%。多因素分析显示，国际妇产科学联合会（FIGO）评分超过12分（危险比1.279,95% CI 1.061 ~ 1.541，P= 0.010）、既往多药化疗失败（危险比3.177,95% CI 1.277 ~ 7.908，P= 0.013）、并发肾转移（危险比2.654,95% CI 1.125 ~ 6.261，P= 0.026）是影响GTN脑转移患者总生存的危险因素。结论GTN脑转移患者经多药化疗及辅助治疗，预后良好。然而，如果患者既往有多药失败化疗史，伴有肾转移，或FIGO评分超过12分，预后较差。早期应用FAEV联合鞘内甲氨蝶呤化疗可为GTN脑转移患者带来光明的前景。
BackgroundThe optimal treatment for patients with brain metastasis from gestational trophoblastic neoplasia (GTN) has not been established. This study aims to investigate the clinical characteristics and the management of brain metastasis from GTN in relation to patients’ outcomes.MethodsWe retrospectively investigated 109 GTN patients with brain metastasis treated at Peking Union Medical College Hospital from January 1990 to December 2013. Patients mainly received multiagent chemotherapy with florouracil or floxuridine, dactinomycin, etoposide, and vincristine (FAEV) combined with intrathecal methotrexate with or without surgery.ResultsIn the 109 patients, sixty-two (56.1%) patients presented for primary therapy and 47 patients had failed chemotherapy elsewhere. Eight early demise patients who died before or during first cycle of chemotherapy were excluded from analysis. The median follow-up time was 47 months (range 9–180 months). The overall 5-year survival rate (OS) was 71.1%, while the OS rate for patients receiving primary chemotherapy in our hospital was 85.5%, and this fell to 51.9% in patients with failure multidrug chemotherapy elsewhere. Multivariate analysis demonstrated that International Federation of Gynecology and Obstetrics (FIGO) scores over 12 (Hazard ratio-HR 1.279, 95% CI 1.061-1.541,P= 0.010), failure of previous multidrug chemotherapy (HR 3.177, 95% CI 1.277-7.908,P= 0.013), and concurrent renal metastasis (HR 2.654, 95% CI 1.125-6.261,P= 0.026) were the risk factors of overall survival in patients with brain metastases from GTN.ConclusionsPatients with brain metastasis from GTN have favorable outcome by multidrug chemotherapy and adjuvant therapies. Nevertheless, the prognosis is poor if the patients had previous multidrug failure chemotherapy history, concomitant with renal metastasis, or FIGO score over 12. Initial treatment with FAEV combined with intrathecal methotrexate chemotherapy can bring bright prospect to patients with brain metastases from GTN.
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DOI：
10.1016/s0020-7292(98)80009-x
发表时间：
1998-04-01
影响因子：
3.8
作者：
Song, HZ;Yang, XY;Xiang, Y
通讯作者：
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影响因子：
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45.3
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Bagshawe, KD
DOI：
10.1111/j.1048-891x.2004.14536.x
发表时间：
2004-09-01
影响因子：
4.8
作者：
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通讯作者：
Hashemi, FA