Diagnosis and management of gestational trophoblastic disease: 2021 update.
Diagnosis and management of gestational trophoblastic disease: 2021 update.
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DOI：
10.1002/ijgo.13877
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发表时间：
2021-10
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妊娠滋养细胞疾病（GTD）起源于异常的胎盘，由一系列癌前病变到恶性病变组成。GTD的流行病学变化已在许多国家被注意到。除了组织学，分子遗传学研究可以帮助诊断途径。超声早期发现葡萄胎妊娠可改变临床表现，降低子宫排空的发病率。随访人绒毛膜促性腺激素（hCG）对早期诊断妊娠滋养细胞肿瘤（GTN）至关重要。hCG监测的持续时间取决于组织学类型和消退率。低风险GTN（FIGO I-III期：评分<7）采用单药化疗治疗，但可能需要额外的药物;尽管评分5-6与更多的耐药性相关，但总生存率接近100%。高危GTN（FIGO II-III期：评分≥7且IV期）采用多药化疗治疗，伴或不伴辅助手术切除耐药病灶或放疗治疗脑转移，生存率约为90%。温和的诱导化疗有助于减少广泛肿瘤负荷患者的早期死亡，但复发性耐药肿瘤仍会导致晚期死亡。妊娠滋养细胞疾病虽然罕见，但需要特别注意，因为如果管理得当，治愈的可能性几乎是100%。
Gestational trophoblastic disease (GTD) arises from abnormal placenta and is composed of a spectrum of premalignant to malignant disorders. Changes in epidemiology of GTD have been noted in various countries. In addition to histology, molecular genetic studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by ultrasound has resulted in changes in clinical presentation and decreased morbidity from uterine evacuation. Follow‐up with human chorionic gonadotropin (hCG) is essential for early diagnosis of gestational trophoblastic neoplasia (GTN). The duration of hCG monitoring varies depending on histological type and regression rate. Low‐risk GTN (FIGO Stages I–III: score <7) is treated with single‐agent chemotherapy but may require additional agents; although scores 5–6 are associated with more drug resistance, overall survival approaches 100%. High‐risk GTN (FIGO Stages II–III: score ≥7 and Stage IV) is treated with multiagent chemotherapy, with or without adjuvant surgery for excision of resistant foci of disease or radiotherapy for brain metastases, achieving a survival rate of approximately 90%. Gentle induction chemotherapy helps reduce early deaths in patients with extensive tumor burden, but late mortality still occurs from recurrent treatment‐resistant tumors. Gestational trophoblastic disease, although rare, needs special attention because if managed properly, likelihood of cure is almost 100%.
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