Relapse rate of patients with low-risk gestational trophoblastic tumor initially treated with single-agent chemotherapy
Relapse rate of patients with low-risk gestational trophoblastic tumor initially treated with single-agent chemotherapy
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DOI：
10.1016/j.ygyno.2004.11.011
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发表时间：
2005-03-01
影响因子：
4.7
通讯作者：
Sekiya, S
中科院分区：
文献类型：
--
作者：
Matsui, H;Suzuka, K;Sekiya, S
目标。目的探讨单药化疗低危妊娠滋养细胞肿瘤(GTT)患者复发的相关因素。1974年至2000年间，272名低风险GTT患者最初接受了甲氨蝶呤(MTX)、放线菌素D(Act-D)或依托泊苷化疗。比较两组患者的初次缓解率、化疗耐药或毒副反应变化及复发率。272例患者总生存率为100%，初次缓解率为75.7%。接受依托泊苷治疗的患者的初次缓解率显著高于常规甲氨蝶呤(P<；0.0001)或甲氨蝶呤-亚叶酸组(P=0.0005)。24例(8.8%)患者因耐药而需改行化疗。甲氨蝶呤-卡介苗的耐药率明显高于依托泊苷(P=0.006)。尽管母亲年龄、有无转移、治疗前hCG滴度较高、有计划的子宫切除对耐药的发生没有影响，但耐药患者的新FIGO评分显著高于未耐药的患者。FIGO评分高、耐药而需更换化疗的患者复发率明显增加。所有低风险GTT患者最终都获得了完全缓解，尽管一些患者对一线化疗产生了耐药性。耐药组复发率明显高于初治缓解组。从长期预后的角度看，耐药少的化疗方案是可取的。(C)2004 Elsevier Inc.保留所有权利。
Objective. To determine the factors for relapse in patients with low-risk gestational trophoblastic tumor (GTT) treated with single-agent chemotherapy.Methods. Between 1974 and 2000, 272 consecutive patients with low-risk GTT were initially treated with methotrexate (MTX), actinomycin D (Act-D) or etoposide chemotherapy. The primary remission rate, change of chemotherapy because of drug resistance or toxicity, and relapse rate were compared.Results. Overall survival rate and primary remission rate for 272 patients were 100% and 75.7%, respectively. Primary remission rate was significantly higher in patients given etoposide than those given conventional MTX (P < 0.0001) or MTX-folinic acid (MTX-CF) (P = 0.0005). Twenty-four (8.8%) patients required a change of chemotherapy because of drug resistance. The frequency of drug resistance was significantly higher in patients treated with MTX-CF than those treated with etoposide (P = 0.006). Although maternal age, presence of metastasis, high pretreatment hCG titer, and planned hysterectomy did not influence the development of drug resistance, the new FIGO scores were significantly higher in patients who developed drug resistance. Relapse rate increased significantly in patients who had high FIGO scores and who required change of chemotherapy due to drug resistance.Conclusions. All patients with low-risk GTT eventually attained complete remission, even though some developed drug resistance to the first-line chemotherapy. The relapse rate was significantly higher in patients with drug resistance than those with primary remission. Chemotherapy regimen that induces little drug resistance is desirable from the viewpoint of long-term prognosis. (c) 2004 Elsevier Inc. All rights reserved.