高危型妊娠滋养细胞肿瘤的评估与治疗

发布时间：2018-02-11 01:05

本文关键词： 妊娠滋养细胞肿瘤高危型妊娠滋养细胞肿瘤联合化疗　出处：《中国癌症杂志》2015年07期 　论文类型：期刊论文

【摘要】：背景与目的:妊娠滋养细胞肿瘤(gestational trophoblastic neoplasm,GTN)是一组起源于胎盘滋养细胞的疾病,因为化疗敏感,绝大多数GTN患者的预后良好。然而,对于高危型GTN由于化疗耐药以及肿瘤复发的存在,其治愈率仅为70%~80%。该研究旨在分析复旦大学附属妇产科医院10年间高危型GTN的诊疗情况。方法:收集2003年1月—2013年1月该院高危型GTN患者的临床资料,从化疗、手术等方面分析其临床特点及其临床转归。结果:10年间我院共收治高危型GTN患者51例,其中5例患者因未完成治疗予以排除,故仅对46例高危型GTN患者予以评估。46例高危型GTN患者,单纯化疗27例,化疗联合手术19例。44例高危型GTN患者接受以EMA-CO(依托泊苷+甲氨蝶呤+Act-D/长春新碱+环磷酰胺)化疗方案为基础的治疗,其中36例患者获得完全缓解(completed response,CR),CR率为81.82%(36/44),8例对EMA-CO耐药;8例EMA-CO化疗方案耐药的患者中,6例更换为EMA-EP(依托泊苷+甲氨蝶呤+Act-D/顺铂+依托泊苷)方案(其中2例接受手术治疗)后获得CR,2例因耐药、疾病进展最终死亡。余2例高危型GTN患者采用其他化疗方案(1例5-FU+KSM,另1例因误诊为持续性异位妊娠接受MTX方案化疗,待手术病理证实为绒癌后由MTX更换为EMA-CO方案)获得CR,故46例患者中,CR率为95.65%(44/46)。19例手术患者中,1例因化疗耐药死亡,余18例均经化疗联合手术治疗获得CR,故手术联合化疗者CR率为94.70%(18/19)。结论:规范的联合化疗对提高高危型GTN的完全缓解率至关重要,手术治疗在高危型GTN治疗中的作用不可忽视。
[Abstract]:Background & objective: gestational trophoblastic neoplasm (GTNN) is a group of placental trophoblastic diseases that are chemosensitive and the majority of GTN patients have a good prognosis. For high-risk GTN due to chemotherapeutic resistance and tumor recurrence, The cure rate was only 70 and 80. The purpose of this study was to analyze the diagnosis and treatment of high-risk GTN in Fudan University Obstetrics and Gynecology Hospital for 10 years. Methods: from January 2003 to January 2013, we collected the clinical data of high-risk type GTN patients in Fudan University. Results 51 cases of high-risk GTN patients were treated in our hospital during the past 10 years, 5 of them were excluded because of incomplete treatment. Therefore, only 46 cases of high-risk GTN patients were evaluated. 46 cases of high-risk GTN patients, 27 cases of chemotherapy alone, Nineteen patients with high risk GTN underwent chemotherapy combined with surgery, and 44 patients received EMA-CO-based chemotherapy based on etoposide methotrexate (Act-D / vincristine cyclophosphamide) regimen. Of the 36 patients with complete remission completed response, the CR rate was 81.82%, including 8 patients who were resistant to EMA-CO and 8 patients who were resistant to EMA-CO regimen. Among them, 6 patients were replaced by EMA-EPan (etoposide methotrexate Act-D / cisplatin etoposide) regimen (2 of which received hand therapy). 2 cases of CRD were obtained after operation. The other 2 patients with high risk GTN received 5-FU KSM, and the other one received MTX regimen because of misdiagnosis as persistent ectopic pregnancy. The CR rate of 46 patients with choriocarcinoma was 95.65 / 46 / 19. One of 19 patients died of chemotherapeutic resistance. The CR rate of the remaining 18 patients was 94.70 / 19. Conclusion: standardized combined chemotherapy is very important to improve the complete remission rate of high risk GTN, and the role of surgical treatment in the treatment of high risk GTN should not be ignored.
【作者单位】：复旦大学附属妇产科医院妇科;
【分类号】：R737.33

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