高预后评分妊娠滋养细胞肿瘤患者化疗疗效及耐药因素分析  

Multiple-drugs chemotherapy efficacy and resistance factors in patients with low-risk gestational trophoblastic neoplasm with high prognostic score

作　　者：陈梦捷 梁月娟 万兵 王鹤[1] CHEN Meng-jie;LIANG Yue-juan;WAN Bing;WANG He(Department of Gynecology Tumor of Guangxi Medical University Cancer Hospital,Nanning 530021,P.R.China)

机构地区：[1]广西医科大学附属肿瘤医院妇瘤科,广西南宁530021

出　　处：《中华肿瘤防治杂志》2020年第4期310-315,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的虽然低危妊娠滋养细胞肿瘤(low risk gestational trophoblastic neplasms,LRGTN)采用单药化疗方案能获得较高的治愈率,但仍有部分预后评分为5~6分的LRGTN患者发生耐药。本研究探讨联合化疗方案治疗高预后评分LRGTN患者的化疗疗效、耐药因素以及最佳联合方案。方法回顾性分析广西医科大学附属肿瘤医院妇瘤科1998-01-01-2016-12-31收治的84例病历信息完整使用联合化疗方案的低危组妊娠滋养细胞肿瘤病例,按2000年改良预后评分分为5~6和0~4分组,对年龄、是否有肺转移、分期及预后评分等可能影响低危组GTN患者疗效及治愈时间的临床因素进行单因素分析,并分别探讨不同联合化疗的疗效。结果5~6分组LRGTN患者诊断为绒癌(χ^2=4.356,P=0.037)、分期晚(χ^2=9.230,P=0.002)以及发生转移(χ^2=11.850,P=0.001)的比例均高于0~4分组,差异有统计学意义。5~6分组LRGTN患者的完全缓解率、耐药率分别为79.31%(23/29)、20.69%(6/29),0~4分组分别为63.64%(35/55)、16.36%(9/55),2组间的完全缓解率(χ^2=2.183,P=0.140)和耐药率(χ^2=0.242,P=0.623)均差异无统计学意义。在5~6分组GTN病例中,耐药组患者年龄≥40岁占4/6,年龄<40岁占2/3,而所有敏感组患者的年龄均<40岁,2组年龄构成比差异有统计学意义,P=0.037。耐药组的终止妊娠距初次化疗的时间间隔平均(4.67±2.88)个月,敏感组则为(2.61±2.21)个月,差异有统计学意义,P=0.033。采用5-FU+KSM±VCR±Vp-16联合化疗方案治疗,5~6分组LRGTN的耐药率为0,MTX+KSM联合化疗方案耐药率为2/4,差异有统计学意义,P=0.037。5-FU+KSM±VCR±Vp-16联合化疗方案治疗5~6分组的LRGTN治愈率为100%(23/23),MTX+KSM联合化疗方案治愈率为4/6,差异有统计学意义,P=0.037。结论年龄≥40岁、终止妊娠与初次治疗的间隔时间较长是容易导致5~6分LRGTN患者对联合化疗耐药的高危因素。另外,5~6分的LRGTN患者可以首先考虑采用5-FU+KSM±VCR±Vp-16联�OBJECTIVE Most of low-risk gestational trophoblastic neoplasms can achieve complete remission by treating with single-drug regimen,but some of them scored 5-6 develop resistance to the single-drug regimen.This study aimed to investigate the efficacy of multiple-drug chemotherapy and factors related to developing resistance in patients with low-risk gestational trophoblastic neoplasms(LRGTN)scored 5-6 and try to find a better regimen to cure these patients.MEDTHODS Retrospective analysis of 84 cases of LRGTN from the Department of Gynecologic Tumors of Guangxi Medical University Affiliated Tumor Hospital was performed.These patients were treated with a multiple-drug chemotherapy regimen.Univariate analysis were performed on clinical factors such as age,metastasis,staging and prognostic scores that may affect the efficacy and time of treatment in patients with LRGTN.Additionally,the efficacy of different multiple-drug regimen was studied.RESULTS The percentage of choriocarcinoma(χ^2=4.356,P=0.037),advanced stage(χ^2=9.230,P=0.002)and metastasis(χ^2=11.850,P=0.001)in the score 5-6 group were significantly higher than that of the score 0-4 group.The complete remission rates(CR)were 79.31%(23/29)and 63.64%(35/55)for the score 5-6 group and the score 0-4 group(χ^2=2.183,P=0.140).The resistant rates were 20.69%(6/29)and 16.36%(9/55)for score 5-6 group and score 0-4 group(χ^2=0.242,P=0.623),respectively.There were no significant differences between the groups.In the score 5-6 group,66.67%(4/6)of the patients in the resistant group were over than 40 years old,and 33.33%(2/3)of the patients were under 40 years old,while all patients in the sensitive group were under40 years old(P=0.037).The mean intervals from end of index pregnancy to chemotherapy in the resistant group and sensitive group were(4.67±2.88)months and(2.61±2.21)months(P=0.033).The resistance rate of multiple-drugs chemotherapy agents 5-FU+KSM±VCR±Vp-16 treating with the LRGTN scored with 5-6 was 0(0/23),while that of multiple-drugs chemotherapy agen

关 键 词：低危组妊娠滋养细胞肿瘤 联合化疗 耐药 更生霉素 氟尿嘧啶 甲氨蝶呤 

分 类 号：R737.33[医药卫生—肿瘤]