Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, the Netherlands.
Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.
BJOG. 2020 Aug;127(9):1139-1145. doi: 10.1111/1471-0528.16198. Epub 2020 Mar 31.
To find risk factors for second-line dactinomycin failure in patients with low-risk gestational trophoblastic neoplasia (GTN).
Retrospective multicentre study.
Tertiary reference centre.
Patients with low-risk GTN, treated with dactinomycin after methotrexate (MTX) failure.
Retrospective analysis of 45 patients with low-risk GTN treated with dactinomycin after MTX failure, registered between 2006 and 2018.
Treatment outcome and risk factors for second-line dactinomycin failure.
Thirty patients (66.7%) were cured and 15 patients (33.3%) required third-line therapy. Type of antecedent pregnancy and hCG levels pre-dactinomycin were risk factors for failure in univariate analysis (odds ratio [OR] 19.30, 95% CI 2.04-182.60, P = 0.01 and OR 2.77, 95% CI 1.18-6.50, P = 0.02, respectively). Level of hCG pre-dactinomycin remained a significant risk factor in multivariate analysis (OR 2.93, 95% CI 1.02-8.40, P = 0.045). Complete remission (CR) was achieved in 83.3% of patients with pre-dactinomycin hCG levels <10 ng/ml, in 75% with hCG levels between 10 and 20 ng/ml, in 66.7% with hCG levels between 20 and 30 ng/ml, and in 50% with hCG levels between 30 and 40 ng/ml. No patients with hCG levels >40 ng/ml achieved CR. Patients with dactinomycin failure were treated surgically and/or with multi-chemotherapy; all except one achieved CR.
Treatment with dactinomycin after MTX failure in patients with low-risk GTN resulted in CR in 66.7%. Chance of curative treatment with dactinomycin is strongly related to the hCG level.
Chance of curative treatment with dactinomycin after MTX failure in GTN patients is strongly related to the level of hCG pre-dactinomycin.
探讨低危妊娠滋养细胞肿瘤（GTN）患者二线放线菌素 D 治疗失败的危险因素。
回顾性多中心研究。
三级参考中心。
接受放线菌素 D 治疗的低危 GTN 患者，这些患者在甲氨蝶呤（MTX）治疗失败后接受了治疗。
对 2006 年至 2018 年间登记的 45 例低危 GTN 患者进行回顾性分析，这些患者在 MTX 治疗失败后接受了放线菌素 D 治疗。
二线放线菌素 D 治疗失败的治疗结果和危险因素。
30 例患者（66.7%）治愈，15 例患者（33.3%）需要三线治疗。单因素分析显示，前次妊娠类型和放线菌素 D 前 hCG 水平是治疗失败的危险因素（比值比[OR] 19.30，95%置信区间[CI] 2.04-182.60，P=0.01 和 OR 2.77，95%CI 1.18-6.50，P=0.02）。多因素分析显示，放线菌素 D 前 hCG 水平仍然是一个显著的危险因素（OR 2.93，95%CI 1.02-8.40，P=0.045）。在 hCG 水平<10ng/ml 的患者中，83.3%达到完全缓解（CR），在 hCG 水平为 10-20ng/ml 的患者中，75%达到 CR，在 hCG 水平为 20-30ng/ml 的患者中，66.7%达到 CR，在 hCG 水平为 30-40ng/ml 的患者中，50%达到 CR。hCG 水平>40ng/ml 的患者无一例达到 CR。放线菌素 D 治疗失败的患者接受了手术和/或多化疗；除 1 例外，所有患者均达到 CR。
在低危 GTN 患者中，MTX 治疗失败后使用放线菌素 D 治疗，66.7%的患者达到 CR。用放线菌素 D 治疗的治愈机会与 hCG 水平密切相关。
在 MTX 治疗失败的 GTN 患者中，用放线菌素 D 治疗的治愈机会与放线菌素 D 前 hCG 水平密切相关。
