Update on the diagnosis and management of gestational trophoblastic disease
Update on the diagnosis and management of gestational trophoblastic disease
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DOI：
10.1002/ijgo.12615
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发表时间：
2018-10-01
影响因子：
3.8
通讯作者：
Massuger, Leon
中科院分区：
文献类型：
--
作者：
Ngan, Hextan Y. S.;Seckl, Michael J.;Massuger, Leon
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）是早期诊断妊娠滋养细胞肿瘤（GTN）的关键。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和IV期）采用多药化疗治疗，伴或不伴切除耐药病灶的辅助手术或脑转移瘤的放疗，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。
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 histology type and regression rate. Low-risk GTN (FIGO Stages I-III: score 7 and Stage IV) is treated with multiple agent 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 resistant tumors.