Noal S, Joly F, Leblanc E
Service de recherche clinique, centre François-Baclesse, 3, avenue du Général-Harris, 14076 Caen cedex 05, France.
Gynecol Obstet Fertil. 2010 Mar;38(3):193-8. doi: 10.1016/j.gyobfe.2010.01.011. Epub 2010 Feb 26.
Gestational trophoblastic diseases comprise of hydatiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumor. Most of those pathologies are chemosensitive and have excellent prognosis, allowing preserving women's fertility because of the low relapse rate during further pregnancies. Physiopathological mechanisms and risk factors are now better understood. Hydatiform moles have to be treated by suction rather than curettage. Placental site trophoblastic tumors are particular chemoresistant pathologies, not secreting hCG which needs specific management. Trophoblastic tumors can be divided into two groups: a low risk group treated by monotherapy, most often by Methotrexate or actinomycine D, with survey about 100% and a high risk group treated by polychemotherapy (Etoposide, Methotrexate, actinomycine D, cyclophosphamide, Vincristine with survey of 86%. Chemorefractarory patients keep deep prognosis with 5 years survival rate of 43%, which allow development of new therapy in this indication. Measurement of hCG remains today central for supervision. A specialised management by an experimented team is essential to give patients better chance of recovery.
妊娠滋养细胞疾病包括葡萄胎、侵蚀性葡萄胎、绒毛膜癌和胎盘部位滋养细胞肿瘤。这些疾病大多对化疗敏感，预后良好，由于再次妊娠时复发率低，可保留女性生育能力。目前对其生理病理机制和危险因素有了更好的了解。葡萄胎必须通过吸宫术而非刮宫术进行治疗。胎盘部位滋养细胞肿瘤是特殊的化疗耐药性疾病，不分泌人绒毛膜促性腺激素（hCG），需要特殊处理。滋养细胞肿瘤可分为两组：低危组采用单一疗法治疗，最常用的是甲氨蝶呤或放线菌素D，治愈率约为100%；高危组采用多药化疗（依托泊苷、甲氨蝶呤、放线菌素D、环磷酰胺、长春新碱），治愈率为86%。化疗耐药患者预后较差，5年生存率为43%，这促使在该领域研发新的治疗方法。如今，hCG检测仍是监测的核心。由经验丰富的团队进行专业管理对于提高患者康复几率至关重要。
