The University of Texas, Houston Health Sciences Center, Houston, TX, USA.
Oregon Health Science University, Portland, OR, USA.
Gynecol Oncol. 2017 Jul;146(1):74-80. doi: 10.1016/j.ygyno.2017.04.017. Epub 2017 May 2.
To determine the efficacy of chemotherapy after failed initial treatment in patients with high risk gestational trophoblastic neoplasia (GTN).
We performed a retrospective IRB-approved chart review of all patients with GTN seen at a single institution from 1985 to 2015, including all patients who failed initial treatment. We summarized clinical characteristics with descriptive statistics and estimated progression-free survival (PFS) and overall survival (OS) with the Kaplan-Meier method.
Of 68 identified patients, 38 required >2 chemotherapy regimens. Patients were treated for GTN (n=53), including choriocarcinoma, persistent GTN, and invasive mole; for placental site trophoblastic tumor (PSTT) (n=5); and for intermediate trophoblastic tumor (ITT) (n=10). Patients with GTN had a median of 2 salvage regimens, median PFS of 4.0months, and median OS was not reached at median follow-up of 71.2months. Active regimens included EMACO, MAC, BEP, platinum- and etoposide-based combination therapies, and ICE; 8 of 53 patients died of disease (DOD). Patients with PSTT had a median of 3 salvage regimens, median PFS of 2.8months, and median OS of 38.8months. Active regimens included ICE and EMA-EP; 4 of 5 patients DOD. Patients with ITT had a median of 3 salvage regimens, median PFS of 4.1months, and median OS of 38.2months. Active regimens included liposomal doxorubicin, platinum-containing regimens, EMA-CO, and EMA-EP; 7 of 10 patients DOD.
Several salvage chemotherapy regimens demonstrate activity in high risk GTN. Multiple regimens may be required and cure is not universal.
确定初始治疗失败的高危妊娠滋养细胞肿瘤（GTN）患者化疗的疗效。
我们对单机构 1985 年至 2015 年间所有 GTN 患者进行了回顾性 IRB 批准的图表审查，包括所有初始治疗失败的患者。我们使用描述性统计方法总结了临床特征，并使用 Kaplan-Meier 方法估计无进展生存期（PFS）和总生存期（OS）。
在 68 例确定的患者中，有 38 例需要>2 种化疗方案。患者接受 GTN（n=53）治疗，包括绒癌、持续性 GTN 和侵袭性葡萄胎；胎盘部位滋养细胞肿瘤（PSTT）（n=5）；和中间滋养细胞肿瘤（ITT）（n=10）。GTN 患者的中位挽救方案为 2 种，中位 PFS 为 4.0 个月，中位 OS 未达到中位随访 71.2 个月。活性方案包括 EMACO、MAC、BEP、铂类和依托泊苷联合治疗以及 ICE；53 例患者中有 8 例因疾病死亡（DOD）。PSTT 患者的中位挽救方案为 3 种，中位 PFS 为 2.8 个月，中位 OS 为 38.8 个月。活性方案包括 ICE 和 EMA-EP；5 例患者中有 4 例 DOD。ITT 患者的中位挽救方案为 3 种，中位 PFS 为 4.1 个月，中位 OS 为 38.2 个月。活性方案包括脂质体多柔比星、含铂方案、EMA-CO 和 EMA-EP；10 例患者中有 7 例 DOD。
多种挽救化疗方案在高危 GTN 中具有活性。可能需要多种方案，且并非所有患者均可治愈。
