Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Laboratory Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Ann Oncol. 2012 Nov;23(11):2903-2906. doi: 10.1093/annonc/mds199. Epub 2012 Jun 22.
We present normograms for human chorionic gonadotropin (hCG) regression in patients with high-risk gestational trophoblastic neoplasia (GTN) successfully treated with multiagent chemotherapy in order to predict treatment resistance.
We collected data for 46 patients with high-risk GTN treated with EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) who had hCG values available. Patients were classified as having methotrexate (MTX)-resistant disease (n = 22) or primary high-risk disease (n = 24). The 10th, 50th and 90th percentiles of the hCG before every chemotherapy course were calculated and plotted in normograms.
Half of the patients treated for MTX-resistant disease and primary high-risk disease had normal hCG levels before the third and sixth course of chemotherapy, respectively. In patients with MTX-resistant disease, the 90th percentile line fell below normal before the start of the fourth course, whereas in patients with primary high-risk disease this was not the case until the eighth course of chemotherapy.
Resistance to EMA/CO treatment for high-risk GTN, as illustrated by examples, could be predicted using normograms for hCG resistance. Normograms differed depending on the indication for multiagent chemotherapy due to much higher initial hCG values in patients with primary high-risk disease compared with those treated for MTX-resistant disease.
我们为成功接受多药化疗治疗的高危妊娠滋养细胞肿瘤（GTN）患者制定了人绒毛膜促性腺激素（hCG）消退的正常值图表，以预测治疗耐药性。
我们收集了 46 例接受依托泊苷、甲氨蝶呤、放线菌素 D、环磷酰胺和长春新碱（EMA/CO）治疗的高危 GTN 患者的数据，这些患者均有 hCG 值。患者分为甲氨蝶呤（MTX）耐药疾病（n=22）和原发性高危疾病（n=24）。计算每个化疗疗程前 hCG 的第 10、50 和 90 百分位数，并绘制在正常值图表中。
一半接受 MTX 耐药疾病和原发性高危疾病治疗的患者，在第三和第六个化疗疗程前 hCG 水平正常。在 MTX 耐药疾病患者中，第 90 百分位数线在第四个疗程开始前降至正常以下，而在原发性高危疾病患者中，直到第八个疗程才出现这种情况。
通过例子表明，高危 GTN 的 EMA/CO 治疗耐药性可以通过 hCG 耐药性的正常值图表来预测。由于原发性高危疾病患者的初始 hCG 值明显高于 MTX 耐药疾病患者，因此基于不同的多药化疗适应证，正常值图表也有所不同。
