Marom Inbal, Lavie Ofer, Schmidt Meirav, Ostrovsky Ludmila, Segev Yakir
The Lady Davis Carmel Medical Center, Haifa, Israel.
The Faculty of Medicine at the Technion, Israeli Institute of Technology, Israel.
Harefuah. 2022 Aug;161(8):494-499.
Gestational trophoblastic disease comprises a spectrum of pregnancy-related disorders, consists of premalignant disorders of complete and partial hydatidiform mole, and malignant disorders such as invasive mole, choriocarcinoma, and the rare placental-site trophoblastic tumor/epithelioid trophoblastic tumor. These malignant forms are termed Gestational Trophoblastic Neoplasia (GTN). Until the early 1960's, hysterectomy was the treatment of choice for women with malignant trophoblastic diseases. The five-year survival rate was 40% for local disease, and around 20% in women with metastases. Chemotherapy, treatment according to the various risk factors and the use of β-hCG values as a marker for monitoring the disease, resulted in a cure rate exceeding 98%, while preserving patient's fertility. Due to its` extremely low incidence with relatively complex treatment protocols, in the presence of high potential for side effects, in most countries there are tertiary centers that coordinate the treatment and follow-up of these diseases. In this review, we will summarize strategies for the primary management of gestational trophoblastic disease, the evaluation and management of malignant gestational trophoblastic neoplasia (GTN) and surveillance after treatment.
妊娠滋养细胞疾病包括一系列与妊娠相关的疾病，由完全性和部分性葡萄胎的癌前疾病以及恶性疾病组成，如侵蚀性葡萄胎、绒毛膜癌和罕见的胎盘部位滋养细胞肿瘤/上皮样滋养细胞肿瘤。这些恶性形式被称为妊娠滋养细胞肿瘤（GTN）。直到20世纪60年代初，子宫切除术一直是患有恶性滋养细胞疾病女性的首选治疗方法。局部疾病的五年生存率为40%，有转移的女性约为20%。化疗、根据各种风险因素进行治疗以及使用β-hCG值作为监测疾病的标志物，使得治愈率超过98%，同时保留了患者的生育能力。由于其发病率极低且治疗方案相对复杂，同时存在较高的副作用风险，在大多数国家都有三级中心来协调这些疾病的治疗和随访。在本综述中，我们将总结妊娠滋养细胞疾病的初始管理策略、恶性妊娠滋养细胞肿瘤（GTN）的评估和管理以及治疗后的监测。
