Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, China.
Int J Gynaecol Obstet. 2024 Apr;165(1):34-42. doi: 10.1002/ijgo.15140. Epub 2023 Sep 27.
Chemotherapy is the recommended treatment for gestational trophoblastic neoplasia (GTN). Second curettage had been advocated to avoid unnecessary chemotherapy and to reduce the courses of chemotherapy; however, consensus has not been reached as there are arguments claiming its inability of inducing complete regression.
The present study was performed to clarify the effectiveness of second curettage for avoiding unnecessary chemotherapy and lowering the number of chemotherapy courses in patients with post-molar GTN.
Seven predominant electronic databases were searched, including four English databases and three Chinese databases, from the inception of each database until January 31, 2023.
Studies were included if they were: (1) human, (2) explicitly indicated exposure to second curettage, (3) explicitly indicated control to conventional chemotherapy, (4) explicitly indicated the participants were patients with gestational trophoblastic neoplasia (GTN), and (5) compared the outcome of interest as the number of the course of chemotherapy.
Two authors extracted and analyzed the data independently. Disagreements were reconciled by reviewing the full text by a third author. The data of study location, data collection, study design, number of participants, intervention strategy, control strategy, the follow-up period, outcome, adverse events were analyzed.
With regard to avoiding unnecessary chemotherapy, the overall pooled effect size of the second curettage group had a significant advantage over the conventional chemotherapy group with an OR of 0.02 (95% CI: 0.00-0.06). Meanwhile, for reducing the number of chemotherapy courses, the overall pooled effect size of the second curettage group had significant advantage over the conventional chemotherapy group with a mean difference of -2.11 (95% CI: -3.72 to -0.51).
The second curettage group had a significant advantage over the conventional chemotherapy group in avoiding unnecessary chemotherapy and reducing the number of chemotherapy courses. Further larger multi-center randomized controlled trials should be conducted to confirm our results and to clarify the optimal patients' group for second curettage in patients with post-molar GTN.
化疗是治疗妊娠滋养细胞肿瘤（GTN）的推荐方法。刮宫术被提倡用于避免不必要的化疗和减少化疗疗程；然而，由于存在其无法诱导完全消退的观点，尚未达成共识。
本研究旨在阐明刮宫术在避免不必要化疗和降低绒癌患者化疗疗程数方面的有效性。
从每个数据库的创建日期到 2023 年 1 月 31 日，共检索了七个主要的电子数据库，包括四个英文数据库和三个中文数据库。
如果研究符合以下标准，则被纳入：（1）人类，（2）明确表明暴露于刮宫术，（3）明确表明对照组接受常规化疗，（4）明确表明参与者为妊娠滋养细胞肿瘤（GTN）患者，（5）比较感兴趣的结果，即化疗疗程数。
两名作者独立提取和分析数据。分歧通过由第三名作者审查全文来解决。分析了研究地点、数据收集、研究设计、参与者数量、干预策略、对照策略、随访期、结局、不良事件等数据。
关于避免不必要的化疗，刮宫术组的总体汇总效应大小明显优于常规化疗组，比值比（OR）为 0.02（95%置信区间：0.00-0.06）。同时，对于减少化疗疗程数，刮宫术组的总体汇总效应大小明显优于常规化疗组，平均差值为-2.11（95%置信区间：-3.72 至-0.51）。
刮宫术组在避免不必要的化疗和减少化疗疗程数方面明显优于常规化疗组。需要进一步开展更大规模的多中心随机对照试验来证实我们的结果，并阐明在绒癌患者中刮宫术的最佳患者群体。
