Kong Yujia, Zong Liju, Cheng Hongyan, Jiang Fang, Wan Xirun, Feng Fengzhi, Ren Tong, Zhao Jun, Yang Junjun, Xiang Yang
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Med. 2020 Apr;9(7):2590-2599. doi: 10.1002/cam4.2901. Epub 2020 Feb 5.
We investigated the clinical characteristics, treatments, and survival of patients with gestational trophoblastic neoplasia (GTN) who experienced recurrence. Factors predictive of recurrence were also investigated.
Patients with GTN who recurred after completing chemotherapy at Peking Union Medical College Hospital Trophoblastic Disease Center were identified between January 2004 and December 2017. Logistic regression analysis was used to identify factors predictive of GTN recurrence.
A total of 1827 patients with GTN achieved complete remission (CR) at our center, of whom 118 (6.5%) experienced recurrence during follow-up. The recurrence rates for patients initially treated at our center and those referred to us were 2.7% and 14.6%, respectively. The majority of recurrent patients received floxuridine-based multiagent chemotherapy (n = 64). Patients who underwent surgery achieved a significantly higher CR rate than those who did not (88.6% vs 61.1%, P = .001). Although 94.1% of recurrent patients reachieved CR, 33.3% of them recurred for a second time. The 5-year survival rate of the entire cohort was 80.4%. An interval between antecedent pregnancy and chemotherapy >12 months (OR: 6.600, 95% CI [3.217-13.540], P < .001), and an interval from first chemotherapy to achieving β-human chorionic gonadotropin (β-hCG) normalization >14 weeks (OR: 2.226, 95% CI [1.080-4.588], P = .030) were predictors of recurrence.
Patients with recurrent GTN are prone to recurring for a second time. Surgery plays a beneficial role in the management of recurrent GTN. An interval between antecedent pregnancy and chemotherapy >12 months, and an interval from first chemotherapy to achieving β-hCG normalization >14 weeks were predictors of recurrence.
我们调查了复发性妊娠滋养细胞肿瘤（GTN）患者的临床特征、治疗方法及生存情况。同时也研究了复发的预测因素。
确定2004年1月至2017年12月在北京协和医院滋养细胞疾病中心完成化疗后复发的GTN患者。采用逻辑回归分析确定GTN复发的预测因素。
共有1827例GTN患者在本中心达到完全缓解（CR），其中118例（6.5%）在随访期间复发。最初在本中心接受治疗的患者和转诊至本中心的患者的复发率分别为2.7%和14.6%。大多数复发患者接受了以氟尿苷为基础的多药化疗（n = 64）。接受手术的患者CR率显著高于未接受手术的患者（88.6%对61.1%，P = 0.001）。虽然94.1%的复发患者再次达到CR，但其中33.3%的患者再次复发。整个队列的5年生存率为80.4%。前次妊娠与化疗间隔>12个月（OR：6.600，95%CI[3.217 - 13.540]，P < 0.001），以及从首次化疗到β-人绒毛膜促性腺激素（β-hCG）正常化的间隔>14周（OR：2.226，95%CI[1.080 - 4.588]，P = 0.030）是复发的预测因素。
复发性GTN患者容易再次复发。手术在复发性GTN的治疗中起有益作用。前次妊娠与化疗间隔>12个月，以及从首次化疗到β-hCG正常化的间隔>14周是复发的预测因素。
