Management and risk factors of recurrent gestational trophoblastic neoplasia: An update from 2004 to 2017
Management and risk factors of recurrent gestational trophoblastic neoplasia: An update from 2004 to 2017
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复发性妊娠滋养细胞肿瘤的治疗和危险因素：2004年至2017年的更新
DOI：
10.1002/cam4.2901
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发表时间：
2020-02-05
期刊：
影响因子：
4
通讯作者：
Xiang, Yang
中科院分区：
文献类型：
--
作者：
Kong, Yujia;Zong, Liju;Xiang, Yang
目的探讨妊娠滋养细胞肿瘤（GTN）复发患者的临床特点、治疗方法和生存率。方法选取2004年1月至2017年12月在北京协和医院滋养细胞疾病中心完成化疗后复发的GTN患者。结果1827例GTN患者在我中心获得完全缓解（CR），其中118例（6.5%）在随访期间复发。最初在我们中心治疗的患者和转诊到我们中心的患者的复发率分别为2.7%和14.6%。大多数复发患者接受了以阿曲库啶为基础的多药化疗（n = 64）。接受手术的患者的CR率显著高于未接受手术的患者（88.6% vs 61.1%，P = 0.001）。94.1%的复发患者获得CR，但33.3%的患者再次复发。全组5年生存率为80.4%。既往妊娠与化疗之间的间隔>12个月（OR：6.600，95%CI [3.217-13.540]，P < .001），以及从首次化疗到获得β-人绒毛膜促性腺激素的时间间隔（β-hCG）恢复正常>14周（OR：2.226，95% CI [1.080-4.588]，P = .030）是复发的预测因素。手术在复发性GTN的治疗中起着有益的作用。既往妊娠与化疗间隔>12个月，首次化疗与β-hCG恢复正常间隔>14周是复发的预测因素。
Objective We investigated the clinical characteristics, treatments, and survival of patients with gestational trophoblastic neoplasia (GTN) who experienced recurrence. Factors predictive of recurrence were also investigated.Methods Patients with GTN who recurred after completing chemotherapy at Peking Union Medical College Hospital Trophoblastic Disease Center were identified between January 2004 and December 2017. Logistic regression analysis was used to identify factors predictive of GTN recurrence.Results A total of 1827 patients with GTN achieved complete remission (CR) at our center, of whom 118 (6.5%) experienced recurrence during follow-up. The recurrence rates for patients initially treated at our center and those referred to us were 2.7% and 14.6%, respectively. The majority of recurrent patients received floxuridine-based multiagent chemotherapy (n = 64). Patients who underwent surgery achieved a significantly higher CR rate than those who did not (88.6% vs 61.1%, P = .001). Although 94.1% of recurrent patients reachieved CR, 33.3% of them recurred for a second time. The 5-year survival rate of the entire cohort was 80.4%. An interval between antecedent pregnancy and chemotherapy >12 months (OR: 6.600, 95% CI [3.217-13.540], P < .001), and an interval from first chemotherapy to achieving beta-human chorionic gonadotropin (beta-hCG) normalization >14 weeks (OR: 2.226, 95% CI [1.080-4.588], P = .030) were predictors of recurrence.Conclusions Patients with recurrent GTN are prone to recurring for a second time. Surgery plays a beneficial role in the management of recurrent GTN. An interval between antecedent pregnancy and chemotherapy >12 months, and an interval from first chemotherapy to achieving beta-hCG normalization >14 weeks were predictors of recurrence.