Pulmonary resection of residual lesions of pulmonary metastasis from gestational trophoblastic neoplasia.
Pulmonary resection of residual lesions of pulmonary metastasis from gestational trophoblastic neoplasia.
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DOI：
10.1136/ijgc-2023-004375
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发表时间：
2023-09-04
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目的评价妊娠滋养细胞瘤肺转移残余病变患者经初始治疗后的预后及复发情况，探讨肺切除术的临床意义。回顾性分析2002年1月至2018年12月北京协和医院606例以标准化化疗为首发治疗的肺转移灶残余病变患者。患者分为手术组（51例）和非手术组（555例）。比较两组患者的预后。分析影响复发的危险因素，探讨肺切除术的效果。在低危患者中，两组完全缓解率均为100%，复发率均<1%。高危患者中，手术组完全缓解率93.5%，复发率10.3%，非手术组94.7%，复发率14.3%。两组患者预后差异无统计学意义（p < 0.05）。两组复发危险因素（≥3.2 cm肺残留病灶、预后评分≥9.0分、耐药）的复发率差异无统计学意义（p < 0.05）。在标准化化疗后，对于血液β人绒毛膜促性腺激素水平正常化且残留肺病变保持稳定的III期妊娠滋养细胞瘤患者，不需要进行肺切除术。这些患者在随访期间应密切监测，无论残余肺病变大小或高/低风险评分，特别是在完全缓解后的一年内。
To evaluate the prognosis and recurrence in patients with residual lesions of pulmonary metastasis from gestational trophoblastic neoplasia after initial treatment, and to explore the clinical significance of pulmonary resection. A retrospective analysis was performed on 606 patients with residual lesions from pulmonary metastasis after receiving standardized chemotherapy as initial treatment in Peking Union Medical College Hospital from January 2002 to December 2018. Patients were divided into surgery (51 patients) and non-surgery (555 patients) groups. The prognosis of these patients was compared. Risk factors affecting recurrence were analyzed to explore the effect of pulmonary resection. Among low risk patients, complete remission rate was 100% and recurrence rate was <1% in both groups. Among high risk patients, complete remission and recurrence rates were 93.5% and 10.3% in the surgery group and 94.7% and 14.3% in the non-surgery group, respectively. There was no significant difference in prognostic features between the two groups (all p>0.05). No significant difference was found in recurrence rates based on recurrence risk factors (≥3.2 cm residual lung lesions, prognosis score ≥9.0, and drug resistance) between the two groups (all p>0.05). After standardized chemotherapy, pulmonary resection was not necessary for initially treated stage III gestational trophoblastic neoplasia patients whose blood β human chorionic gonadotropin levels normalized and residual lung lesions remained stable. These patients should be closely monitored during follow-up, regardless of the size of the residual lung lesions or high/low risk score, especially within a year after complete remission.
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3.9
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