Newlands E S, Bower M, Holden L, Short D, Brock C, Rustin G J S, Begent R H J, Bagshawe K D
Department of Medical Oncology Charing Cross Hospital Fulham Palace Road London W6 8RF, U.K.
Mount Vernon Centre for Cancer Mount Vernon Hospatal Northwood Middlesex HA6 2RN, U.K.
Int J Gynaecol Obstet. 1998 Apr;60 Suppl 1:S65-S70. doi: 10.1016/S0020-7292(98)80007-6.
Between 1979 and 1995 we have treated 272 consecutive women with high-risk (GTT including 121 previously treated patients who were treated with the weekly EMA/CO (etoposide, methotrexate, actinomycin D alternating with cyclophosphamide and vincristine). The median follow-up is 4.5 years (range 1-16 years). The cumulative 5 year survival is 86.2% (95% confidence interval 81.9-90.5%). No deaths from GTT occurred later than 2 years after starting EMA/CO. In a multivariate analysis, adverse prognostic factors were the presence of liver metastases (p < 0.0001), interval from antecedent pregnancy > 24 months (p < 0.0001), brain metastases (p = 0.0008) and term delivery of antecedent pregnancy (p = 0.045). There were 11 (4%) early deaths while 213 (78%) achieved complete remission. 47 (17%) developed drug resistance to EMA/CO of whom 33 (70%) were salvaged by further cisplatinum based chemotherapy and sugery. 2 women developed acute myeloid leukaemia after treatment with EMA/CO. 56% of women who have been in remission for at least 2 years and had fertility conserving surgery have achieved pregnancy since completing EMA/CO and there have been 112 live births including 3 babies with congenital abnormalities. EMA/CO is an effective, easy to administer and well tolerated regimen for treating patient with high-risk GTT. More than half of these women will retain their fertility. However, there is a small but significant increase in second malignancies.
1979年至1995年间，我们连续治疗了272例高危妊娠滋养细胞肿瘤（GTT）患者，其中包括121例曾接受过治疗的患者，这些患者接受了每周一次的EMA/CO方案（依托泊苷、甲氨蝶呤、放线菌素D与环磷酰胺和长春新碱交替使用）治疗。中位随访时间为4.5年（范围1 - 16年）。5年累积生存率为86.2%（95%置信区间81.9 - 90.5%）。开始EMA/CO治疗后2年内未发生因GTT导致的死亡。多因素分析显示，不良预后因素包括肝转移（p < 0.0001）、前次妊娠间隔>24个月（p < 0.0001）、脑转移（p = 0.0008）和前次妊娠足月分娩（p = 0.045）。有11例（4%）早期死亡，213例（78%）实现完全缓解。47例（17%）对EMA/CO产生耐药，其中33例（7o%）通过进一步的铂类化疗和手术挽救。2例女性在接受EMA/CO治疗后发生急性髓系白血病。至少缓解2年且接受保留生育功能手术的女性中，56%在完成EMA/CO治疗后成功妊娠，共有112例活产，其中包括3例有先天性异常的婴儿。EMA/CO是治疗高危GTT患者的一种有效、易于给药且耐受性良好的方案。这些女性中超过一半将保留生育能力。然而，继发性恶性肿瘤有小幅但显著的增加。
