Gordon A N, Gershenson D M, Copeland L J, Saul P B, Kavanagh J J, Edwards C L
Obstet Gynecol. 1985 Apr;65(4):550-6.
The clinical course of 61 patients with high-risk metastatic gestational trophoblastic disease was reviewed. Currently, 34 patients (56%) are alive and in complete remission. The survival rate after full-term pregnancy was significantly worse than after any other type of antecedent pregnancy. Analyzing survival by individual high-risk criteria revealed significantly improved survival for those patients with elevated beta-human chorionic gonadotropin titer alone when compared with all other high-risk criteria. Fifty-eight percent of patients (14 of 24) primarily treated with alternating-sequential therapy consisting of methotrexate and actinomycin-D experienced a complete remission. Of those patients primarily treated with methotrexate, actinomycin-D, and cyclophosphamide, 63% (20 of 32) achieved a complete remission. Treatment with second-line chemotherapy was largely unsuccessful. Aggressive early treatment is warranted in this group of patients, using multiagent chemotherapy. A search for newer more effective regimens should continue.
回顾了61例高危转移性妊娠滋养细胞疾病患者的临床病程。目前，34例患者（56%）存活且处于完全缓解状态。足月妊娠后的生存率明显低于任何其他类型的既往妊娠。根据个体高危标准分析生存率发现，单纯β-人绒毛膜促性腺激素水平升高的患者与所有其他高危标准相比，生存率有显著提高。主要接受由甲氨蝶呤和放线菌素-D组成的交替序贯疗法治疗的患者中，58%（24例中的14例）实现了完全缓解。主要接受甲氨蝶呤、放线菌素-D和环磷酰胺治疗的患者中，63%（32例中的20例）实现了完全缓解。二线化疗的治疗效果大多不佳。对于这组患者，有必要采用多药化疗进行积极的早期治疗。应继续寻找更新、更有效的治疗方案。
