EMA/CO for High-Risk Gestational Trophoblastic Neoplasia: Good Outcomes With Induction Low-Dose Etoposide-Cisplatin and Genetic Analysis
EMA/CO for High-Risk Gestational Trophoblastic Neoplasia: Good Outcomes With Induction Low-Dose Etoposide-Cisplatin and Genetic Analysis
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DOI：
10.1200/jco.2012.43.1817
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发表时间：
2013-01-10
影响因子：
45.3
通讯作者：
Seckl, Michael J.
中科院分区：
文献类型：
--
作者：
Alifrangis, Constantine;Agarwal, Roshan;Seckl, Michael J.
目的高危妊娠滋养细胞肿瘤（GTN）患者（国际妇产科联盟评分≥ 7分）经常接受依托泊苷、甲氨蝶呤和更生霉素与环磷酰胺和长春新碱交替每周治疗（EMA/CO）。在1979年至1995年期间，在我们研究所使用该方案的总生存率（OS）为85.4%，早期死亡（< 4周）的比例很高。在这里，我们确定生存率是否有改善，在最近的患者队列（1995年至2010年）。患者和MethodsPatients接受EMA/CO确定使用查林十字GTN数据库。遗传分析确定了非妊娠滋养细胞肿瘤（nGTT）。自1995年以来，使用诱导低剂量依托泊苷100 mg/m（2）和顺铂20 mg/m（2）（EP;第1天和第2天，每7天），以减少早期死亡开始EMA/CO注意到。6名患者患有nGTT，140名患者患有高危疾病，250名患者患有复发/耐药低风险GTN。高风险患者的OS为94.3%（90.4%，包括nGTT），低风险组为99.6%，中位随访时间为4.2年。所有nGTT患者和7例高危GTN患者均死于耐药疾病。23.1%的高危患者接受EP诱导化疗（140例患者中的33例）疾病负担较大，早期死亡率仅为0.7%（n = 1; 95%CI，0.1%至3.7%）相比，7.2%（n = 11的151例患者; 95%CI，4.1%至12.6%）在1995年前coherent.ConclusionOS后EMA/CO的高危GTN增加了近9%。这反映了通过使用基因诊断排除非典型表现患者中的nGTT（3.9%）更准确地估计OS。在选定的个体中进行低剂量诱导EP也可以几乎完全消除早期死亡。后者应在高危GTN中常规考虑。J Clin Oncol 31：280-286. (C)2012年美国临床肿瘤学会
PurposePatients with high-risk (International Federation of Gynecology and Obstetrics score >= 7) gestational trophoblastic neoplasia (GTN) frequently receive etoposide, methotrexate, and dactinomycin alternating weekly with cyclophosphamide and vincristine (EMA/CO). Between 1979 and 1995, overall survival (OS) with this regimen at our institute was 85.4% with a significant proportion of early deaths (< 4 weeks). Here, we determine whether survival rates have improved in a more recent patient cohort (1995 to 2010).Patients and MethodsPatients receiving EMA/CO were identified using the Charing Cross GTN database. Genetic analysis identified nongestational trophoblastic tumors (nGTTs). The use of induction low-dose etoposide 100 mg/m(2) and cisplatin 20 mg/m(2) (EP; days 1 and 2 every 7 days) since 1995 to reduce early deaths before commencing EMA/CO was noted.ResultsFour hundred thirty-eight patients received EMA/CO between 1995 and 2010. Six patients had nGTTs, 140 had high-risk disease, and 250 had relapsed/resistant low-risk GTN. OS was 94.3% in high-risk patients (90.4% including nGTTs) and 99.6% in the low-risk group, with a median follow-up time of 4.2 years. All patients with nGTT and seven patients with high-risk GTNs died as a result of drug-resistant disease. EP induction chemotherapy was given to 23.1% of high-risk patients (33 of 140 patients) with a large disease burden, and the early death rate was only 0.7% (n = 1; 95% CI, 0.1% to 3.7%) compared with 7.2% (n = 11 of 151 patients; 95% CI, 4.1% to 12.6%) in the pre-1995 cohort.ConclusionOS after EMA/CO for high-risk GTN has increased by nearly 9%. This reflects a more accurate estimate of OS by excluding nGTTs (3.9%) in patients with atypical presentations using genetic diagnosis. Low-dose induction EP in selected individuals also allows near complete elimination of early deaths. The latter should be considered routinely in high-risk GTN. J Clin Oncol 31:280-286. (C) 2012 by American Society of Clinical Oncology