Yang Xy

Diagnosis and management of uterine arteriovenous fistulas with massive vaginal bleeding

To study the clinical manifestations, diagnosis, management, and prognosis of uterine arteriovenous fistulas with massive vaginal bleeding.

Molecular Genetic Analyses of Choriocarcinoma

BACKGROUND Choriocarcinoma is a highly malignant trophoblastic neoplasm. Most of them are gestational in origin, while non-gestational ones are exceedingly rare. The genetic origin, immunogenicity, sensitivity to chemotherapy and prognosis of these two kinds of conditions are quite different, so identification of these two kinds of choriocarcinoma is of great importance. The objective of this study is to distinguish choriocarcinoma as gestational or non-gestational and identify the causative pregnancy of gestational choriocarcinoma through molecular genetic analysis. METHODS Twelve patients with choriocarcinoma, who had experienced surgery prior to chemotherapy, were enrolled in this study. DNA was prepared from blood samples from the patient and her partner using standard techniques. In order to prepare DNA from choriocarcinoma tissue, areas of choriocarcinoma were firstly microdissected from haematoxylin and eosin-stained sections. PCR amplification and fluorescent microsatellite genotyping were performed using DNA from the couples and captured tissue. The genetic contributions to the choriocarcinoma were determined by comparing the genotypes of the choriocarcinoma and that of the couples. RESULTS Four of twelve cases had only a maternal contribution, indicating a non-gestational origin. The remaining eight cases were all gestational in origin and the causative pregnancies were identified as AnCHM (androgenetic complete hydatidiform mole) in six and normal pregnancies in two respectively. CONCLUSION Microsatellite polymorphism analysis is a molecular approach for distinguishing the non-gestational choriocarcinoma from the gestational one, and can also be used to identify the causative pregnancy of gestational choriocarcinoma. Antecedent pregnancy prior to choriocarcinoma is not always its causative pregnancy. Therefore, it is reasonable to identify the causative pregnancy by its genetic origin, instead of clinical impression.

The prognostic analysis of 123 postpartum choriocarcinoma cases

A retrospective analysis of 123 postpartum choriocarcinoma cases treated at the Peking Union Medical College Hospital between December 1985 and December 2006 was performed. All the patients with postpartum choriocarcinoma received chemotherapy, combined with comprehensive therapy. The total number of chemotherapy cycles was 1041 (8.5 for every patient on average). The complete remission (CR) was achieved in 108 patients (87.8%), whereas five patients had partial remission and ten died. Of the 26 patients who became resistant to 5-fluorouracil combined chemotherapy, 18 achieved CR. Of the four cases who had recurrence, three achieved CR. The patients were divided into high- and low-risk groups, based on the new FIGO 2000 risk factor scoring system. Seventy-five patients were in high-risk group, with a score of 7 or more. Among them, 62 achieved CR (82.7%). The remaining 48 patients were in the low-risk group, with a score of 6 or less, among whom 46 patients achieved CR (95.8%). There is a significant difference in CR rate between the two groups. Based on the FIGO staging and scoring system, 24 patients were diagnosed as FIGO stage I, 9 stage II, 66 stage III, and 24 stage IV. The rate of CR was 100%, 100%, 91%, and 62.5%, respectively. Our experience shows that prognosis of postpartum choriocarcinoma is good when multiagent systemic chemotherapy is applied. Shortened time interval between the antecedent pregnancy and the treatment will lead to better prognosis

Clinical parameters predicting therapeutic response to surgical management in patients with chemotherapy-resistant gestational trophoblastic neoplasia

OBJECTIVE Several studies have reported that surgical management of chemotherapy-resistant gestational trophoblastic neoplasia (GTN) is a useful adjunct to chemotherapy. We investigated the pretreatment predictive factors of therapeutic response in response to surgical management combined with chemotherapy. METHODS The study involved 61 patients with chemotherapy-resistant GTN who underwent surgery between January 1996 and January 2007. Responses to the combination therapy with surgery and chemotherapy were assessed after the end of treatment. Statistical analyses were performed to identify preoperative clinical factors associated with response of chemotherapy-resistant GTN. RESULTS After the end of combination therapy, 47 (77.0%), 4 (6.6%), 1 (1.6%), and 9 (14.8%) of 61 patients showed complete response (CR), partial remission (PR), stable disease (SD), and progressive disease (PD), respectively. Univariate analysis found that predictors of response were age (p=0.022), antecedent pregnancy (p=0.022), site of metastasis (p=0.026), and preoperative serum human chorionic gonadotropin-beta subunit (beta-hCG) level (p=0.027). All patients with treatment failure had 2 or more of unfavorable factors, including age older than 35 years, antecedent non-molar pregnancy, distant metastasis outside of lungs and uterus, and preoperative serum beta-hCG level greater than 10 IU/L. CONCLUSIONS The data suggest that age older than 35 years, antecedent non-molar pregnancy, distant metastasis outside of lungs and uterus, and a preoperative serum beta-hCG level greater than 10 IU/L are important clinical predictors of treatment failure to surgery. They may benefit in the selection of salvage surgery as well as the assessment of individual prognosis.

Surgical resection in the management of pulmonary metastatic disease of gestational trophoblastic neoplasia.

The objective of this study was to evaluate the influence of surgical resection on survival outcome in patients with gestational trophoblastic neoplasia with pulmonary metastatic disease. Medical records of 62 patients with gestational trophoblastic neoplasia who underwent pulmonary lobectomy or limited resection were reviewed. The cases were divided into 3 groups, namely, the recurrent group (group A), the drug-resistant group (group B), and the group with satisfactory response to chemotherapy but with residual pulmonary lesion (group C). The proportion of high-risk patients was significantly lower in group C, whereas this group had a remarkable complete remission rate of 100% with no relapse recorded, and only 3 patients (12.0%) in this group had a positive histologic diagnosis. The complete remission rates of groups A and B were 88.9% and 78.6%, respectively, and the relapse rates were 14.3% and 15.0%, respectively. By comparing treatment failure cases with patients who achieved complete remission, factors that might affect the clinical outcome of pulmonary surgery were also analyzed. Patients who have received more than 4 regimens or 13 courses of preoperative chemotherapy seemed to have unfavorable prognosis (P < 0.05). Follow-ups could be carried out without surgical resection for patients with satisfactory response to chemotherapy but with residual pulmonary lesions. Pulmonary surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug-resistance and the lesions are relatively localized. However, surgery is not advisable for patients who received more than 4 regimens or 13 courses of preoperative chemotherapy.

Emergency craniotomy in patients with intracranial metastatic gestational trophoblastic tumor

To study the diagnosis, management and prognosis of intracranial metastases of gestational trophoblastic tumor (GTT) patients who had emergency craniotomy.