标题：
Evaluation and suggestions for improving the FIGO 2000 staging criteria for gestational trophoblastic neoplasia: an analysis of 1420 cases
讲者：
蒋芳
单位：
北京协和医院
播放：
5178
论文摘要：
Purpose
To evaluate the influence and value of current prognostic factors for the treatment of malignant gestational trophoblastic neoplasia and to identify opportunities to improve the system.
Material and Methods
Clinical data from the Gestational Trophoblastic Disease (GTD) center at Peking Union Medical Hospital (PUMCH) collected between January 2002 and December 2013 were retrospectively analyzed. The different prognostic scores of the patients were evaluated. Univariate and multivariate analyses of each prognostic factor were performed using the Cox proportional hazards model. A new prognostic score scale was established according to the multivariate analysis of the hazard ratio (HR) values. The area under the ROC curve of the original score was compared with the Z score of the matched design to evaluate the effect of the new scale.
Results
1. Among the 1420 cases included in the study, the median follow-up time was 40 months (range 6-163 months).; the overall complete remission (CR) rate was 95.8%. The relapse rate was 7.1%. The mortality rate was 5.5%. The median disease-free survival was 36 months (range 0-163 months).
2. The CR rate was 99.8% (915/917) among low-risk patients (0-6 points) and 88.5% (445/503) among high-risk patients (P<0.001), with corresponding mortality rates of 0.3% and 15.1% respectively (P<0.001).
3. The univariate and multivariate analyses showed that age, pretreatment serum human chorionic gonadotropin beta-subunit (β-hCG) levels and maximum tumor diameter were not independent risk factors for the prognosis. Antecedent pregnancy, interval from index pregnancy, number of metastases and previous failed chemotherapy were independent prognostic risk factors.
4. We suggested a modified scoring system based the HR values calculated in the Cox analysis. The total score in the modified system is 16 points, with a cut-off value of 6 points. The area under the ROC curve is significantly increased using this system.
Conclusion
The FIGO 2000 Trophoblastic Neoplasia Staging System is an effective scoring system, but its accuracy and operability require improvements. Some factors in the current system may not be independent risk factors for patient prognosis, thus the weights of other factors should be adjusted appropriately.
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