The added value of hysterectomy in the management of gestational trophoblastic neoplasia
The added value of hysterectomy in the management of gestational trophoblastic neoplasia
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DOI：
10.1016/j.ygyno.2017.03.018
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发表时间：
2017-06-01
影响因子：
4.7
通讯作者：
Ottevanger，P. B.
中科院分区：
文献类型：
--
作者：
Eysbouts，Y. K.;Massuger，L. F. A. G.;Ottevanger，P. B.
背景尽管化疗治疗妊娠滋养细胞肿瘤（GTN）的疗效已被证实，但化疗的毒性和化疗耐药的问题已引起人们对子宫切除术的重新考虑。本研究的目的是评估适应症和结果的子宫切除术患者GTN在nationwide coherent.MethodsBetween 1977年和2012年，我们确定了所有患者诊断为GTN和治疗子宫切除术从荷兰国家数据库。人口统计学，临床特征和后续recording.Results109例（16.5%的所有登记患者GTN）进行子宫切除术的一部分，他们的管理GTN。大多数患者被归类为低风险疾病（74.3%），磨牙后GTN（73.5%）和局限于子宫的疾病（65.1%）。子宫切除术后，66.2%的局限性疾病患者和15.8%的转移性疾病患者达到完全缓解。对于局限性疾病的患者，采用初次子宫切除术治疗，治疗时间明显缩短（平均分别为3.2周和8.0周，p = 0.01），化疗周期数较少（平均值分别为1.5和5.8，p < 0.01）。子宫切除术可能是减少或消除肿瘤体积的有效手段。原发性子宫切除术应主要考虑在老年患者局限性疾病和不希望保留生育能力，而化疗耐药的疾病患者可能会受益于额外的子宫切除术，特别是当疾病是局部的。对于广泛转移性疾病的患者，子宫切除术的益处在于切除化疗耐药的肿瘤块，随后影响生存率。
BackgroundDespite the undoubted effectiveness of chemotherapeutic treatment in gestational trophoblastic neoplasia (GTN), problems related to toxicity of chemotherapy and chemo-resistant disease have led to reconsideration of the use of hysterectomy. Aim of the present study was to evaluate indications for and outcome of hysterectomy in patients with GTN in a nation-wide cohort.MethodsBetween 1977 and 2012, we identified all patients diagnosed with GTN and treated with hysterectomy from the Dutch national databases. Demographics, clinical characteristics and follow-up were recorded retrospectively.ResultsOne hundred and nine patients (16.5% of all registered patients with GTN) underwent hysterectomy as part of their management for GTN. The majority of patients was classified as low-risk disease (74.3%), post-molar GTN (73.5%) and disease confined to the uterus (65.1%). After hysterectomy, complete remission was achieved in 66.2% of patients with localized disease and in 15.8% of patients with metastatic disease. For patients with localized disease, treated with primary hysterectomy, treatment duration was significantly shorter (mean 3.2 weeks and 8.0 weeks respectively, p = 0.01) with lower number of administered chemotherapy cycles (mean 1.5 and 5.8 respectively, p < 0.01) than patients in a matched control group.ConclusionIn selected cases, a hysterectomy may be an effective means to either reduce or eliminate tumor bulk. Primary hysterectomy should mainly be considered in older patients with localized disease and no desire to preserve fertility, whereas patients with chemotherapy-resistant disease may benefit from additional hysterectomy, especially when disease is localized. For patients with widespread metastatic disease, the benefit of hysterectomy lies in the removal of chemotherapy-resistant tumor bulk with subsequent effect on survival.