Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
J Obstet Gynaecol Res. 2022 Jun;48(6):1451-1457. doi: 10.1111/jog.15228. Epub 2022 Mar 14.
To explore the risk factors for re-recurrence in relapsed gestational trophoblastic neoplasia (GTN) and therapeutic approaches to reduce the re-recurrence rate.
Data of relapsed GTN treated in the Obstetrics and Gynecology Hospital of Fudan University from January 1, 2015, to December 31, 2020, were reviewed retrospectively. Risk factors associated with re-recurrence were analyzed using Logistic regression analysis.
A total of 39 relapsed GTN patients were included in our study. At the time of the first relapse, 14 patients received single-agent chemotherapy and 25 patients received multi-agent chemotherapy. Surgery was performed in 19 patients. Complete remission was achieved in all of the patients. Re-recurrence occurred in 21 patients. Univariate analysis suggested that unifocal recurrence was the only factor significantly associated with re-recurrence (OR = 0.25, p = 0.04). Recurrence pattern-based subgroup analysis showed that the proportion of re-recurrence was lower in patients who received both surgery and chemotherapy compared to those who received only chemotherapy in the unifocal recurrence group (3/11 vs. 2/4), but not in the non-unifocal recurrence group (7/8 vs. 9/16). The results of the multivariate analysis showed that there was no significant difference in re-recurrence rates between the surgical approaches and that the non-unifocal recurrence pattern was an independent risk factor for re-recurrence.
For relapsed GTN with unifocal recurrence pattern, surgical removal of the lesion can effectively reduce the re-recurrence rate.
探讨复发性妊娠滋养细胞肿瘤（GTN）的再复发风险因素及降低再复发率的治疗方法。
回顾性分析复旦大学附属妇产科医院 2015 年 1 月 1 日至 2020 年 12 月 31 日收治的复发性 GTN 患者的临床资料，采用 Logistic 回归分析与再复发相关的危险因素。
本研究共纳入 39 例复发性 GTN 患者。在首次复发时，14 例患者接受单药化疗，25 例患者接受多药化疗。19 例患者接受了手术治疗。所有患者均达到完全缓解。21 例患者发生了再复发。单因素分析表明，单病灶复发是唯一与再复发显著相关的因素（OR=0.25，p=0.04）。基于复发模式的亚组分析显示，在单病灶复发组中，接受手术联合化疗的患者再复发比例低于仅接受化疗的患者（3/11 比 2/4），但在多病灶复发组中差异无统计学意义（7/8 比 9/16）。多因素分析结果表明，手术方式对再复发率无显著影响，多病灶复发模式是再复发的独立危险因素。
对于单病灶复发的复发性 GTN，手术切除病灶可有效降低再复发率。
