Second Uterine Curettage and the Number of Chemotherapy Courses in Postmolar Gestational Trophoblastic Neoplasia
Second Uterine Curettage and the Number of Chemotherapy Courses in Postmolar Gestational Trophoblastic Neoplasia
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磨牙后妊娠滋养细胞肿瘤的第二次清宫术和化疗疗程数
DOI：
10.1097/aog.0000000000003441
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发表时间：
2019
影响因子：
7.2
通讯作者：
Usui Hirokazu
中科院分区：
文献类型：
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作者：
Tamada Hazuki;Ebara Takeshi;Matsuki Taro;Kato Sayaka;Sato Hirotaka;Ito Yuki;Saitoh Shinji;Kamijima Michihiro;Sugiura-Ogasawara Mayumi;on behalf of the Japan Environment and Children’s Study Group;Usui Hirokazu
回复：我们想回复Dr. Jasani关于我们2019年5月号文章的评论。1这是第二项随机研究，旨在评估第二次刮宫术在低风险妊娠滋养细胞肿瘤中的作用。我们特别研究了获得人绒毛膜促性腺激素正常化所需的化疗周期数，而Osborne等人的妇科肿瘤组研究关注避免化疗，因此他们专注于通过第二次刮宫治愈。2在我们的研究中，我们注意到第二次刮除标本的组织病理学检查根本没有发现磨牙组织。我们假设，在这种情况下，刮宫术不会治愈和化疗将是强制性的。正如Dr.Dagli所建议的那样，只有新的研究才能解决这个问题和其他问题。这样的研究应该在国际合作中完成，并关注对我们的患者很重要的问题，例如患者的偏好和遗憾，总治疗时间，尝试怀孕的时间，再次怀孕的时间和随后的妊娠结局，以及第二次刮宫的可能缺点，例如出血，感染和Asherman综合征。此外，还需要长期随访，以明确第二次刮宫是否与再次妊娠后的妊娠滋养细胞肿瘤有关，正如我们在一例患者中观察到的那样。我们感谢Dr. Alzhei提醒我们注意我们文章中表1中报告的患者的非预期不良性能状态。这应该是“世卫组织评分”，而不是“绩效评分”。我们对此错误深表歉意。
In Reply: We would like to reply to Dr. Usui’s comments regarding our article in the May 2019 issue. 1 This was the second randomized study to evaluate the role of second curettage in low-risk gestational trophoblastic neoplasia. We particularly studied the number of chemotherapy cycles needed to obtain normalization of human chorionic gonadotropin, whereas the Gynecologic Oncology Group study by Osborne et al concerns avoidance of chemotherapy, so they focused on cure by second curettage. 2 In our study, we noticed that histopathologic examination of the second curettage specimen did not reveal molar tissue at all. We hypothesize that, in such cases, curettage will not cure and chemotherapy will be compulsory. As suggested by Dr. Usui, only new studies would be able to address this and other issues. Such a study should be done in an international collaboration and focus on queries that are important for our patients, such as patients’ preferences and regrets, total treatment duration, time until attempting pregnancy, time until subsequent pregnancy, and subsequent pregnancy outcome, as well as possible drawbacks of second curettage, such as bleeding, infection, and Asherman’s syndrome. Additionally, long-term follow-up will be needed to clarify whether second curettage is related to gestational trophoblastic neoplasia after a subsequent pregnancy, as was observed in one of our patients. We thank Dr. Usui for alerting us on the not-to-be expected poor performance status of the patients reported in Table 1 in our article. This should be “WHO score” and not “performance score.” We apologize for this error.