Savage Philip, Seckl Michael, Short Delia
Department of Medical Oncology, Charing Cross Hospital, London, UK.
J Reprod Med. 2008 Oct;53(10):774-80.
Using data primarily from Charing Cross Hospital in London, we examined the organization and funding of patients' care and follow-up, the value of second evacuations, the indications for treatment escalation and the results of treating patients with persistent low levels of human chorionic gonadotropin (hCG) following a molar pregnancy. In the U.K. system the total cost per patient treated is approximately $30,000. Second evacuations appear to have only a modest chance (18%) of benefit in patients with hCG levels over 5,000 IU/L. Outcome analysis of patients with low-risk gestational trophoblastic tumor (GTT) treated with methotrexate/folinic acid indicates that hCG levels in excess of500 IU/L at 7 weeks after starting are an accurate predictor of impending methotrexate resistance. For patients with hCG values under 100 IU/L at the time of treatment, a review of the 30 most recent low-risk GTT patients demonstrates a 100% cure rate with standard treatment. Low-risk GTT following a molar pregnancy is a highly curable malignancy, and cure rates approaching 100% should be expected. National or regional organization of follow-up and treatment is simple, economic and associated with enhanced outcomes when appropriate treatment policies are followed.
我们主要利用伦敦查令十字医院的数据，研究了患者护理及随访的组织与资金投入、二次清宫的价值、治疗升级的指征以及葡萄胎妊娠后持续性低水平人绒毛膜促性腺激素（hCG）患者的治疗结果。在英国的医疗体系中，每位接受治疗的患者的总成本约为30,000美元。对于hCG水平超过5000 IU/L的患者，二次清宫似乎只有适度的获益机会（18%）。对采用甲氨蝶呤/亚叶酸治疗的低风险妊娠滋养细胞肿瘤（GTT）患者的结果分析表明，开始治疗7周后hCG水平超过500 IU/L是即将出现甲氨蝶呤耐药的准确预测指标。对于治疗时hCG值低于100 IU/L的患者，回顾30例最近的低风险GTT患者发现，标准治疗治愈率为100%。葡萄胎妊娠后的低风险GTT是一种高度可治愈的恶性肿瘤，预期治愈率接近100%。当遵循适当的治疗政策时，全国或地区性的随访及治疗组织简单、经济且能改善治疗结果。
