[Factors related to recurrence of choriocarcinoma and evaluation of treatment outcomes].
OBJECTIVE
To analyse the factors associated with recurrence of choriocarcinoma and to evaluate the treatment outcomes of choriocarcinoma.


METHODS
The records of 490 patients with choriocarcinoma treated at Peking Union Medical College Hospital (PUMCH) were reviewed and evaluated for recurrent episodes of choriocarcinoma.


RESULTS
Three hundred and ninety-four women achieved primary remission; 17 (4.3%) developed one or more episodes of recurrent choriocarcinoma. Recurrent rate in low-risk patients was 2.4% (5/208), while in high-risk patients 6.5% (12/186). Recurrent rates among those without and with 1 course of maintenance chemotherapy patients were 6.1% (3/49) and 9.8% (6/61) respectively, while in 2, 3, and >3 courses of maintenance therapy patients were 1.4% (1/70), 3.9% (2/51) and 3.1% (5/163) respectively. Thirteen (76.5%, 13/17) patients with recurrent choriocarcinoma recurred within 3 years and 4 patients after 3 years. Sixteen (94.1%) of 17 patients achieved secondary remission; 6 (37.5%) of 16 developed a second recurrence, and one was lost to follow-up after partial remission. In addition, 21 patients were referred to PUMCH from other hospitals for salvage therapy at the time of recurrence. Totally 38 patients of recurrent choriocarcinoma were treated at our hospital; 29 recurred once, 7 recurred twice and 2 recurred 4 times. There were totally 51 instances treated for recurrent choriocarcinoma. The complete remission rates in patients using chemotherapy only was 69.2% (18/26), the second recurrent rates of these patients was 50.0% (9/18); the complete remission rates in patients using chemotherapy combined with surgery was 92.0% (23/25), the second recurrent rates of these patients was 17.4% (4/23).


CONCLUSIONS
Factors related to development of recurrent choriocarcinoma include high-risk at initial evaluation and less than two courses of maintenance chemotherapy beyond the primary remission. Most patients of recurrent choriocarcinoma recur within 3 years; the recurrent choriocarcinoma is of poor prognosis and should be treated aggressively. Chemotherapy combined with surgery is the most important method to increase cure rates and to decrease recurrent rates.
Sun
Yin
Y
Department of Obstetrics and Gynecology, College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Xiang
Yang
Y
Wan
Xi-run
XR
Yang
Xiu-yu
XY
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002822:Choriocarcinoma / Q000097:blood / Q000473:pathology / Q000628:therapy*; D006063:Chorionic Gonadotropin / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D009364:Neoplasm Recurrence, Local; D011247:Pregnancy; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*
D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D005472:Fluorouracil