单药化疗和联合化疗方案在初治低危型妊娠滋养细胞肿瘤中的疗效及其影响因素  

Efficacy of single agent chemotherapy and combination chemotherapy in the initial treatment of low-risk gestational trophoblastic tumor and its influencing factors

作　　者：林美娥 LIN Meie(Department of Gynecology,the Second Affiliated Hospital of Fujian Medical University,Fujian Province,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院妇产科,福建省泉州市362000

出　　处：《临床合理用药》2025年第4期28-32,共5页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的 观察单药化疗和联合化疗方案在初治低危型妊娠滋养细胞肿瘤中的疗效及其影响因素。方法 回顾性分析2018年5月—2020年5月于福建医科大学附属第二医院治疗的200例低危型妊娠滋养细胞肿瘤患者的临床资料,根据化疗方案不同分为单药化疗组和联合化疗组,每组100例。单药化疗组给予甲氨蝶呤化疗方案,联合化疗组给予依托泊苷+甲氨蝶呤+环磷酰胺+长春新碱化疗方案,14 d为1个疗程,化疗期间监测患者血β-人绒毛膜促性腺激素水平,待该指标恢复正常后需持续化疗1~3个周期。比较2组完全缓解率、耐药情况及不良反应。根据临床疗效将患者分为缓解组(n=172)和耐药组(n=28),对影响疗效的指标进行单因素分析,将差异有统计学意义的因素纳入多因素Logistic回归分析模型,筛选影响低危型妊娠滋养细胞肿瘤疗效的因素。结果 联合化疗组完全缓解率高于单药化疗组(100.00%vs. 72.00%,χ^(2)=32.558,P<0.001),单药化疗组耐药率为28.00%,联合化疗组未出现耐药患者。联合化疗组白细胞减少、中性粒细胞减少、脱发的发生率均高于单药化疗组,口腔黏膜炎发生率低于单药化疗组(P<0.01)。与缓解组比较,耐药组年龄大、非葡萄胎、距前次妊娠间隔时间4~7 d及FIGO预后评分5~6分比例均升高(P<0.01);多因素Logistic回归分析显示,FIGO预后评分是影响化疗疗效的因素(OR=4.085,P=0.002)。结论 在初治低危型妊娠滋养细胞肿瘤患者治疗中,对于存在高危因素的患者可以依托泊苷+甲氨蝶呤+环磷酰胺+长春新碱化疗方案为首选方案,针对FIGO预后评分较高的低危型妊娠滋养细胞肿瘤患者,仍需要更多化疗方案研究。Objective To observe the efficacy and influencing factors of single drug chemotherapy and combination chemotherapy in the initial treatment of low-risk gestational trophoblastic tumor.Methods Clinical data of 200 patients with low-risk gestational trophoblastic tumor treated in the Second Affiliated Hospital of Fujian Medical University from May 2018 to May 2020 were retrospectively analyzed.They were divided into single-drug chemotherapy group and combined chemotherapy group according to different chemotherapy regimen,with 100 cases in each group.The single-drug chemotherapy group was given methotrexate chemotherapy regimen,and the combined chemotherapy group was given etoposide+methotrexate+cyclophosphamide+vincristine chemotherapy regimen,14 days as a course of treatment.During chemotherapy,bloodβ-human chorionic gonadotropin level of patients was monitored,and continuous chemotherapy was required for 1 to 3 cycles after the index returned to normal.The complete remission rate,drug resistance and adverse reactions were compared between the two groups.According to the clinical efficacy,the patients were divided into remission group(n=172)and drug-resistant group(n=28).Univariate analysis was performed on the indicators affecting the efficacy,and the factors with statistical significance were incorporated into the multivariate Logistic regression analysis model to screen the factors affecting the efficacy of low-risk gestational trophoblastic tumor.Results The complete response rate in combination chemotherapy group was higher than that in monotherapy group(100.00%vs.72.00%,χ^(2)=32.558,P<0.001).The rate of drug resistance was 28.00%in the single drug chemotherapy group,and no drug resistance occurred in the combination chemotherapy group.The incidence of leukopenia,neutropenia and alopecia in combination chemotherapy group was higher than that in single drug chemotherapy group,and the incidence of oral mucositis was lower than that in single drug chemotherapy group(P<0.01).Compared with the remission group,th

关 键 词：妊娠滋养细胞肿瘤 初治 低危型 单药化疗 联合化疗 完全缓解率 影响因素 

分 类 号：R73[医药卫生—肿瘤]