Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, No. 1 Xueshi Road, Hangzhou, 310006, Zhejiang, China.
Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
BMC Womens Health. 2023 Jan 2;23(1):1. doi: 10.1186/s12905-022-02134-w.
To evaluate whether prophylactic chemotherapy (P-chem) increased the drug resistance rate of postmolar GTN and whether the first-line chemotherapy should be different from P-chem.
Postmolar GTN received P-Chem was defined as P-Chem group. Postmolar GTN without P-chem was randomly selected as control group according to the ratio of 1:3 (P-chem:control) and matched by age for low risk and high risk GTN separately.
Totally 455 low-risk and 32 high-risk postmolar GTN patients were included. WHO risk score, chemotherapy cycles to achieve hCG normalization and resistant rate were similar between P-chem (27 cases) and control (81 cases) group. Among low-risk GTN patients, interval from hydatidiform mole to GTN was significantly longer in P-chem group than control (44 vs 69 days, P = 0.001). Total chemotherapy cycles and resistant rate were similar between low-risk GTN treated with same agent as P-chem (group A) and alternative agent (group B). But group A needed more chemotherapy cycles to achieve hCG normalization than group B.
P-chem delayed the time to GTN diagnosis, but didn't increase risk score or lead to drug resistance of postmolar GTN. Alternative agent different from P-chem had the potential of enhancing chemotherapy response in low- risk postmolar GTN.
评估预防性化疗（P-chem）是否会增加绒癌（GTN）患者的耐药率，以及一线化疗是否应不同于 P-chem。
接受 P-Chem 的绒癌患者被定义为 P-Chem 组。根据 1:3（P-chem:control）的比例，随机选择未经 P-chem 的绒癌患者作为对照组，并按低危和高危 GTN 分别进行年龄匹配。
共纳入 455 例低危和 32 例高危绒癌患者。P-chem（27 例）组和对照组（81 例）的 WHO 风险评分、达到 hCG 正常化的化疗周期数和耐药率相似。在低危 GTN 患者中，P-chem 组从葡萄胎到 GTN 的间隔时间明显长于对照组（44 天 vs 69 天，P=0.001）。采用与 P-chem 相同药物治疗的低危 GTN（A 组）和替代药物治疗的低危 GTN（B 组）的总化疗周期数和耐药率相似。但 A 组达到 hCG 正常化所需的化疗周期数多于 B 组。
P-chem 延迟了 GTN 的诊断时间，但并未增加风险评分或导致绒癌耐药。与 P-chem 不同的替代药物可能增强低危绒癌的化疗反应。
