摘要
目的探讨采用新的临床分期后,甲氨蝶呤单药初次化疗治疗低危妊娠滋养细胞肿瘤(GTN)的疗效及其影响因素。方法对61例接受甲氨蝶呤单药化疗的GTN患者根据2000年国际妇产科联盟(FIGO)临床分期标准进行重新评分,收集其中低危患者的临床资料进行回顾性分析,对患者年龄、化疗前血人绒毛膜促性腺激素(hCG)、末次妊娠性质、开始治疗距末次妊娠间隔时间、临床分期和预后评分、肺部X线和CT检查结果、病灶大小、不同给药方案与其疗效进行单因素和多因素分析。结果在61例低危GTN患者中对51例采用甲氨蝶呤5日化疗,35例(68.6%)近期完全缓解;10例采用甲氨蝶呤+甲酰四氢叶酸化疗,3例获近期完全缓解;其余患者经更换化疗方案后均达近期完全缓解。经单因素分析,化疗前hCG、距末次妊娠时间、病灶大小、FIGO评分、不同给药方案与甲氨蝶呤单药化疗疗效显著相关(P均<0.05)。经向后删除法二项分类Logistic回归多因素分析,结果甲氨蝶呤的给药方案、FIGO预后评分和化疗前的hCG水平与甲氨蝶呤单药化疗疗效显著相关(OR值分别为2.476、1.431和1.001)。结论采用新的FIGO临床分期后,对低危GTN首选甲氨蝶呤单药化疗仍是一种选择,但其缓解率有所下降;甲氨蝶呤方案、FIGO预后评分和化疗前的血hCG水平是甲氨蝶呤单药化疗疗效的独立影响因素。
Objective To evaluate the effects of primary chemotherapy with single-agent methotrexate （MTX） on low-risk gestational trophoblastic neoplasia （GTN） and the influencing factors thereof. Methods Sixty-one GTN patients with the score of ≤ 6 according to the new International Federation of Gynecology and Obstetrics （FIGO） scoring system （2000） were divided into 2 groups： 51patients were treated with single MTX 0. 4 mg/kg daily for 5 days （ MTX 5 d group）, and 10 patients were treated with MTX on the days 1,3, 5, and 7, and with folinic acid （FA） 0.1 mg/kg on the days 2, 4, 6,and 8 （ MTX ＋ FA group）, both group with an interval of treatment course of 2 weeks. The serum level of human chorionic gonadotropin （hCG） was detected every week. If a plateau or increase of serum hCG appeared between 2 examination results, meaning tolerance to MTX, the patients concerned had to undergo different regimens of salvage chemotherapy, all with MTX as one of their components. Univariate and multivariate methods were used to analyze the relationships of different factors to the outcomes of chemotherapy. Results Thirty-five of the 51 patients of the MTX 5d group （68.6%） achieved complete primary remission, 3 of the 10 patients of the MTX ＋ FA group achieved complete primary remission, and all patients achieved complete remission after salvage chemotherapy. Univariate analysis showed that the mean pretreatment serum level of hCG, duration between antecedent pregnancy and start of treatment, size of tumor, FIGO score, specific regimen of MTX were significantly associated with outcome of chemotherapy（ P = 0.004, 0.022, 0. 017, 0. 005, 0. 021 respectively ）, Logistic regression analysis showed that only three independent factors predictive for the outcome of chemotherapy ： MTX regimen （ OR = 2.476 ）, FIGO score （ OR = 1.431 ）, and pretreatment hCG titer （ OR = 1.001 ）, Conclusion Primary chemotherapy with single MTX regimen may still be one of the options for patients with low-risk GTN according to the new FIGO scoring system, though the rate of complete primary remission appears to be lower. All patients with low-risk GTN achieve complete remission after salvage chemotherapy, MTX regimen, FIGO score, and pretreatment hCG are independent risk factors of outcome of single MTX chemotherapy.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2005年第30期2109-2112,共4页
National Medical Journal of China
