甲氨蝶呤单药治疗低危妊娠滋养细胞肿瘤的疗效及其相关因素的研究  

Curative effects and influenced factors of primary chemotherapy with single-agent methotrexate on low-risk gestational trophoblastic neoplasia

作　　者：吴晓东[1] 陈丽莉[1] 沈涛[1] 陈思诗[1] 陈钦清[1] 秦佳乐[1] 傅云峰[1] 吕卫国[1] 

机构地区：[1]浙江大学医学院附属妇产科医院,杭州310006

出　　处：《中华医学杂志》2017年第23期1769-1772,共4页National Medical Journal of China

基　　金：基金项目：妇产科国家临床研究中心资金资助（2015BA113805）;浙江省公益技术研究社会发展项目（2013C33151,2016C33153）;浙江省医药卫生科技项目（2016KYA123）;浙江省医药卫生一般研究计划（2016KYB164）

摘　　要：目的探讨甲氨蝶呤（MTX）单药治疗低危妊娠滋养细胞肿瘤（LRGTN）的疗效及其相关影响因素。方法收集浙江大学医学院附属妇产科医院2001年1月至2015年6月收治的259例符合条件的LRGTN患者的临床资料并进行回顾性分析，所有患者均按照2000年国际妇产科联盟（FIGO）临床分期标准进行评分，对患者年龄、前次妊娠性质、距前次妊娠间隔时间、化疗前血人绒毛膜促性腺激素（HCG）水平、最大病灶大小、转移灶数目、临床分期和预后评分与其疗效进行单因素和多因素分析。结果259例患者中183例（70.66%，183/259）经甲氨蝶呤单药化疗后达到完全缓解，余76例经补救化疗后均达到完全缓解。单因素分析显示，FIGO预后评分、化疗前血HCG水平、距前次妊娠间隔时间与甲氨蝶呤单药初次化疗疗效显著相关（P＝0.001, 0.018, 0.014）。多因素分析显示，FIGO预后评分（OR＝4.094）和前次妊娠性质（OR＝0.268）是甲氨蝶呤单药化疗疗效的独立影响因素。FIGO预后评分≤4分的238例患者中63例（26.47%，63/238）出现耐药，而〉4分的21例患者中13例（61.90%，13/21）出现耐药。结论MTX单药化疗对于LRGTN而言仍是一种有效的治疗方案，FIGO预后评分、前次妊娠性质是影响甲氨蝶呤单药化疗疗效的独立因素。Objective To evaluate the efficacy of primary chemotherapy with single-agent methotrexate （MTX） for low-risk gestational trophoblastic neoplasia and to analysis the influenced factors.Methods We retrospectively reviewed 259 cases with low-risk gestational trophoblastic neoplasia whose primary chemotherapies were MTX 0.4 mg·kg^-1 （maximum 25 mg） daily for 5 days every other week. Patients′ data between January 2001 and June 2015 was collected and the relationships of different factors to outcomes of chemotherapy were also evaluated.Results 183 of the 259 patients （70.66%, 183/259） achieved complete primary remission and all patients achieved complete remission after salvage chemotherapy. Univariate analysis showed that FIGO score, serum level of HCG before treatment and interval months from previous pregnancy were significantly associated with outcome of chemotherapy （P=0.001, 0.018, 0.014 respectively）. Logistic regression analysis showed that the FIGO score （OR=4.094） and antecedent pregnancy （OR=0.268） were two independent factors predictive for the outcome of chemotherapy.Conclusions Primary chemotherapy with single-agent MTX may still be one of the options for patients with low risk GTN. The FIGO score and antecedent pregnancy are two independent risk factors of outcome of single-agent MTX chemotherapy.

关 键 词：妊娠滋养细胞肿瘤 甲氨蝶呤 化学治疗 

分 类 号：R737.33[医药卫生—肿瘤]