Risk factors for second-line dactinomycin failure after methotrexate treatment for low-risk gestational trophoblastic neoplasia: a retrospective study
Risk factors for second-line dactinomycin failure after methotrexate treatment for low-risk gestational trophoblastic neoplasia: a retrospective study
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DOI：
10.1111/1471-0528.16198
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发表时间：
2020-03-31
影响因子：
5.8
通讯作者：
Ottevanger, P. B.
中科院分区：
文献类型：
--
作者：
Hoeijmakers, Y. M.;Sweep, F. C. G. J.;Ottevanger, P. B.
目的探讨低危妊娠滋养细胞瘤（GTN）患者放线菌素二线失效的危险因素。设计回顾性多中心研究。设置三级参考中心。低风险GTN患者，甲氨蝶呤（MTX）治疗失败后使用放线菌素治疗。方法回顾性分析2006年至2018年登记的45例MTX治疗失败后使用放线菌素治疗的低危GTN患者。主要结局指标：二线放线菌素失败的治疗结局和危险因素。结果治愈30例（66.7%），需三线治疗15例（33.3%）。单因素分析中，妊娠类型和放线菌素使用前hCG水平是失败的危险因素（比值比[OR] 19.30, 95% CI 2.04 ~ 182.60, P = 0.01；比值比[OR] 2.77, 95% CI 1.18 ~ 6.50, P = 0.02）。在多因素分析中，放线菌素前hCG水平仍然是显著的危险因素（OR 2.93, 95% CI 1.02-8.40, P = 0.045）。在使用放线菌素前hCG水平为40 ng/ml的患者中，83.3%的患者达到了完全缓解（CR）。放线菌素治疗失败的患者接受手术和/或联合化疗；结论低危GTN患者MTX治疗失败后给予放线菌素治疗，CR率为66.7%。放线菌素治疗的治愈机会与hCG水平密切相关。摘要GTN患者MTX治疗失败后放线菌素治愈率与放线菌素治疗前hCG水平密切相关。
Objective To find risk factors for second-line dactinomycin failure in patients with low-risk gestational trophoblastic neoplasia (GTN).Design Retrospective multicentre study.Setting Tertiary reference centre.Population Patients with low-risk GTN, treated with dactinomycin after methotrexate (MTX) failure.Methods Retrospective analysis of 45 patients with low-risk GTN treated with dactinomycin after MTX failure, registered between 2006 and 2018.Main outcome measures Treatment outcome and risk factors for second-line dactinomycin failure.Results Thirty patients (66.7%) were cured and 15 patients (33.3%) required third-line therapy. Type of antecedent pregnancy and hCG levels pre-dactinomycin were risk factors for failure in univariate analysis (odds ratio [OR] 19.30, 95% CI 2.04-182.60, P = 0.01 and OR 2.77, 95% CI 1.18-6.50, P = 0.02, respectively). Level of hCG pre-dactinomycin remained a significant risk factor in multivariate analysis (OR 2.93, 95% CI 1.02-8.40, P = 0.045). Complete remission (CR) was achieved in 83.3% of patients with pre-dactinomycin hCG levels 40 ng/ml achieved CR. Patients with dactinomycin failure were treated surgically and/or with multi-chemotherapy; all except one achieved CR.Conclusions Treatment with dactinomycin after MTX failure in patients with low-risk GTN resulted in CR in 66.7%. Chance of curative treatment with dactinomycin is strongly related to the hCG level.Tweetable abstract Chance of curative treatment with dactinomycin after MTX failure in GTN patients is strongly related to the level of hCG pre-dactinomycin.