Clinical Analysis Of148Cases Of Gestation Trophoblastic Neoplasia

Objective:The purpose of this paper is to find out and to understand what haschanged in gestational trophoblastic neoplasm(GTN) in main aspect includingage of onset, gravidity, clinical manifestation,GTN staging, GTN risk factorscoring, treatment and effect.Methods:Use the retrospective analysis, and collect the patients from January2002to December2013, who were made a definite diagnosis of gestationaltrophoblastic neoplasm in the NO.2hospital of Hebei province. All thepatients are divided into three groups，every four years into a group. The threegroups are respectively the year from2002to2005as Group One, the yearfrom2006to2009as Group Two, and year from2010to2013as Group ThreeResults:1) There is no obvious difference of age of onset of IHM between threegroups. But the proportion of age from20to29in each group is becominghigher and higher while the age from30to39and the age beyoung40has nochange. P=0.049，P＜0.052) The trend of gravidity, abortion and delivery of CC and IHM havesimilar change tendency in each group. But there is no difference in IHMpatients between three groups. P=0.658、 P=0.711、 P=0.819， P＞0.05.Gravidity of CC in Group Three is lower than Group Two P=0.027，P＜0.05.And the number of patients that the diease occurred on their first pregnancydecreased P=0.04，P<0.053) The proportion of no clinical symptoms (40%) in Group Three is muchhigher than other two groups,18.9%（10/53）,31.3%（15/48）,40%（30/75）,P=0.04，P<0.05. The cases of CC come from hydatidiform mole are short. More patients whose last pregnancy were normal got CC.4) The GTN staging of IHM patients has some changes in three groups.Such as the Stage Ⅲ in Group Three has more patients than other stages,theproportion of Stage Ⅲ is76%(33/43), higher than other two groupsP=0.043，P<0.05. But the risk factor score has no change among the threegroups P＞0.05.5)There is no significant difference of blood β-HCG between twogroups P=0.283，P＞0.05. In the Group Two the bloodβ-HCG of Stage Ⅲis higher than StageⅠ. In the Group Three, the situation is not same. Nodifference between two stages P=0.024，P=0.06. Take adventage of the pelvicDoppler ultrasound, patients of IHM that no lesion in their uterus reducedP=0.037，P<0.05, while patients of CC has not the same results.6) The proportion of patients accepted operation treatment decreasedsignificantly, the number of patients only received chemotherapy accountedabsolutely for all patients, but patients that resistant to chemotherapy increased.The proportion that the blood β-HCG of patients who had accepted firstchemotherapy regimen was down to a logarithmic below decreased P=0.045，P<0.05. And the chemotherapy regimens that patients need to accept to makethe blood β-HCG normal became longer P=0.031，P<0.05.5-fluorouracil doseobviously reduced P=0.007，P＜0.05.Conclusion:1) The age distribution of patients of GTN has not changed, but thenumber of age from20to29has ascended. Patients of GTN become youngerthan before.2) The relationship between gravidity and morbidity is not closelyas usually.3) The clinical manifestation has changed a lot. Nowadays mostpatients seem to normal without symptoms.4) The GTN staging of patients ishigher than before,Stage Ⅲ is common and has a largest number of patients,but the mean of risk factor scoring has not changed much. So GTN was easierto metastatic, and malignant was same.5) Blood β-HCG was still the sensitiveindicator. The Blood β-HCG of stage Ⅲ and stageⅠhave difference inGroup Two but the difference has disappear in Group Three.6) More and more patients were received chemotherapy only. Chemotherapy drugresistance increased, and the reason probably was that the dose of5-fluorouracil is reduced.