低危绒癌性妊娠滋养细胞肿瘤一线治疗采用放线菌素 D 脉冲疗法。
Pulse actinomycin D as first-line treatment of low-risk post-molar non-choriocarcinoma gestational trophoblastic neoplasia.
机构信息
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China.
出版信息
BMC Cancer. 2018 May 23;18(1):585. doi: 10.1186/s12885-018-4512-5.
BACKGROUND
Little data exists predicting the resistance to actinomycin D (Act-D) single-agent for gestational trophoblastic neoplasia (GTN). The objective was to determine the overall success of pulse Act-D and the factors predictive of resistance to pulse Act-D in the treatment of low-risk, non-choriocarcinoma post-molar GTN.
METHODS
From January 2013 to October 2016, according to the FIGO criteria for the diagnosis of post-molar disease and the FIGO risk-factor scoring system for GTN, a total of 135 patients with post-molar non-choriocarcinoma GTN who were chemotherapy-naive with a FIGO score < 7 were treated with single-agent pulse Act-D as a first-line regimen, in Peking Union Medical College Hospital. The pulse Act-D regimen is defined as 1.25 mg/m (max 2 mg) IV push every other week. All patients were followed until May 2017. Epidemiological and clinical data were compared between patients with remission and resistance to Act-D to determine predictive factors by univariate and multivariate analysis.
RESULTS
Ninety-six of 135 patients (71.1%) achieved complete remission after first-line chemotherapy of pulse Act-D. In multivariate analysis, existing invasive uterine lesions observed by pre-chemotherapy transvaginal ultrasound (odds ratio [OR] 7.5, 95% confidence intervals [CI] 2.7-20.8), FIGO score ≥ 5 (OR 15.2, 95% CI 1.5-156.1) and pre-chemotherapy levels of β-hCG ≥ 4000 IU/L (OR 3.1, 95% CI 1.2-8.3) were independent high-risk factors predicting resistance to pulse Act-D as single-agent chemotherapy. During follow-up, no relapse, treatment-associated serious adverse events, or death occurred.
CONCLUSIONS
As first-line chemotherapy, pulse Act-D was effective and tolerable for patients with low-risk post-molar non-choriocarcinoma. Existing invasive uterine lesions observed by pre-chemotherapy transvaginal ultrasound, a FIGO score ≥ 5, and pre-chemotherapy levels of β-hCG ≥ 4000 IU/L were independent factors for resistance to pulse Act-D.
背景
关于放线菌素 D（Act-D）单药治疗妊娠滋养细胞肿瘤（GTN）耐药性的数据很少。本研究的目的是确定脉冲 Act-D 的总体疗效，并确定低危、非绒癌性葡萄胎后 GTN 患者对脉冲 Act-D 耐药的预测因素。
方法
根据国际妇产科联盟（FIGO）诊断绒癌后疾病的标准和 GTN 的 FIGO 危险因素评分系统，2013 年 1 月至 2016 年 10 月，在我院对 135 例化疗初治、FIGO 评分＜7 的低危、非绒癌性葡萄胎后 GTN 患者采用单药脉冲 Act-D 作为一线治疗方案。脉冲 Act-D 方案定义为每两周静脉推注 1.25mg/m（最大 2mg）。所有患者均随访至 2017 年 5 月。比较 Act-D 缓解组和耐药组患者的流行病学和临床资料，采用单因素和多因素分析确定预测因素。
结果
135 例患者中，96 例（71.1%）经一线化疗脉冲 Act-D 治疗后完全缓解。多因素分析显示，化疗前经阴道超声检查发现的子宫内浸润性病变（优势比 [OR] 7.5，95%置信区间 [CI] 2.7-20.8）、FIGO 评分≥5（OR 15.2，95%CI 1.5-156.1）和化疗前β-HCG≥4000IU/L（OR 3.1，95%CI 1.2-8.3）是预测脉冲 Act-D 单药化疗耐药的独立高危因素。随访期间，无复发、与治疗相关的严重不良事件或死亡发生。
结论
作为一线化疗方案，脉冲 Act-D 治疗低危绒癌后非绒癌性 GTN 有效且耐受良好。化疗前经阴道超声检查发现的子宫内浸润性病变、FIGO 评分≥5 和化疗前β-HCG≥4000IU/L 是脉冲 Act-D 耐药的独立因素。
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