| Objective: The clinical data of 92 cases of non-malignant hydatidiform mole and48 cases of GTN after hydatidiform mole were analyzed to explore the risk factors for the occurrence of GTN after hydatidiform mole.Methods: A total of 140 patients with hydatidiform mole were selected from2012.1.1 to 2019.12.31 in the Department of Gynecology of Gansu Provincial Hospital.Clinical data of all included patients were collected.1.Using retrospective investigation and research,the clinical data of all collected 177 patients were sorted and analyzed,and 140 cases were finally included and divided into HM non-malignant group(n=92)and GTN group(n=48)according to whether malignant transformation occurred.2.By comparing the basic clinical data of the two groups(age,chief complaints,number of pregnancies,number of miscarriages,blood type(A,B,O,AB blood type),pathological type after uterine curettage,number of uterine curettage,gestational weeks,hCG before uterine curettage,hCG after uterine curettage)analyzing the risk factors of GTN after hydatidiform mole.3.SPSS 26.0 statistical software was used for data analysis.P<0.05 was considered statistically significant.Results: 1.There was no significant difference in chief complaint,ABO blood type,times of pregnancy,times of abortion,gestational weeks,hCG before uterine curettage and hCG after uterine curettage(P>0.05).The proportion of patients aged≥35 years with GTN(29.2%)was significantly higher than that of the group without malignant transformation(13%),P < 0.05 by chi-square test,with statistical significance,and patients aged≥35 years had a higher risk of malignant transformation.The majority of GTN patients had more than or equal to two uterine curettages,accounting for 68.8%(33/48),which was significantly higher than that of the nonmalignant group(40.2%),the chi-square test result was P<0.01,patient who had more than 2 uterine curettages had a higher risk of malignant transformation.Most of the included cases were CHM(n=102),among which 67.4%(62/92)were in the nonmalignant transformation group and 83.3%(40/48)were in the GTN group.The difference between the two groups was significant(P<0.05),indicating that CHM patients were prone to post-hydatidiform mole GTN.2.Binary Logistic regression analysis: age≥35 years was a risk factor for GTN after HM,P = 0.045,OR = 2.761,and the difference was statistically significant(P<0.05);the frequency of uterine curettage≥2 was a risk factor for GTN after hydatidiform mole,(P=0.000,OR=4.587),with statistical significance(P < 0.01).There was no correlation between pathological type after uterine curettage,gestational weeks,and hCG before uterine curettage and the occurrence of GTN after hydatidiform mole.Conclusion: 1.The risk of GTN is increased with age≥35 years old and more times of uterine curettage.2.Chief complaint,ABO blood type,times of pregnancies,times of abortions,gestational weeks,pathological type after uterine curettage,hCG before and after uterine curettage had no correlation with the occurrence of GTN after hydatidiform mole.Objective: To explore the factors influencing the choice of chemotherapy regimen and the analysis of the treatment effect of different chemotherapy regimens.Methods: Using retrospective analysis,the clinical data of 48 patients were collected.On the basis of the different initial treatment and chemotherapy regimens,patients were divided into single-drug group(single-agent chemotherapy group)of 35 cases(referred to as single-drug group)and multi-drug group(multi-drug combination chemotherapy group)of 13 cases.Comparing the clinical data of the two groups,the relationship between various factors and different chemotherapy regimens,and the efficacy of chemotherapy were analyzed.Results: 1.Comparing of the clinical data between the single-drug group and the multi-drug group,there were no differences in age,pregnancy times,number of abortions,pathological type after uterine curettage,number of uterine curettage,hCG before and after uterine curettage,Time and Time1 between the two groups(P>0.05).There were 33 patients with abnormal hCG,23 patients in single drug group and 10 patients in multi-drug group.There was no significant difference in FIGO stage and prognosis score(P>0.05).The shortest time from the beginning of chemotherapy to the first decrease of hCG to normal in the single-drug group was 25 days,the longest was 296 days,with an average of 118 days,and that in the multi-drug group was 35 days,the longest was 164 days,with an average of 94 days.For patients with multidrug chemotherapy,the time for hCG to return to normal was shorter,and there as no significant difference between the two groups by nonparametric test(P>0.05).26 of the 48 patients had metastasis,one of whom developed vaginal wall metastasis with lung metastasis,and the remaining patients developed only lung metastasis.Patientswith metastasis in the multi-drug group were significantly more than that in the singledrug group,respectively: 69.2% and 48.6%(P<0.05).Patients with hCG≥104m IU/ml before chemotherapy in the multi-drug group(61.5%)(P<0.05).2.Binary Logistic regression analysis : there was no correlation between metastasis,gestational weeks,hCG before uterine curettage and the choice of chemotherapy regimen for GTN.Patients with hCG≥104m IU/ml before chemotherapy were more likely to choose multi-drug combination chemotherapy,and the difference was significant(P<0.05).3.In 48 patients with GTN after hydatidiform mole,the response rates of single-drug chemotherapy and multi-drug combination chemotherapy were 65.8%(22/35)and 92.3%(12/13),respectively.The hCG before chemotherapy,time from uterine curettage to the start of chemotherapy,metastasis and FIGO score had no correlation with the occurrence of drug resistance.The younger the GTN patients were,the higher the risk of chemotherapy resistance was,and the difference was significant(P<0.05),But the results of Binary Logistic regression analysis showed that P=0.196,that is,there was no correlation between age and drug resistance of GTN after hydatidiform mole.In patients with drug resistance during chemotherapy,the time for HCG to decrease to normal was prolonged(P < 0.05).Regression analysis results showed that the difference was statistically significant(P=0.009,OR=1.045).Conclusion: 1.There was nothing between the choice of chemotherapy and the patients’ age,pregnancy times,frequency of abortions,pathological types after uterine clearance,hCG before and after uterine curettage,metastatic,gestational weeks,time from uterine curettage to the beginning of chemotherapy,FIGO stage and score.2.The patients with hCG≥104m IU/ml before chemotherapy are more likely to choose multidrug combination chemotherapy.3.Age,hCG before chemotherapy,the time from uterine curettage to the beginning of chemotherapy,metastasis and FIGO score were not related to the occurrence of drug resistance.Patients who developed resistance to chemotherapy had a prolonged time for hCG to fall to normal. |
PDF Full Text Request