Uberti Elza Maria Hartmann, de Freitas Medeiros Lidia Rosi, Cardoso Rodrigo Bernardes, Muller Karine Paiva, Patias Cassiano Burman, Nunes Thaís Feiten, Reis Rosilene Jara, Marçal Josenel Maria Barcelos
Coordinator of the Center for Trophoblastic Diseases at Maternidade Mario Totta of Irmandade de Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Brazil.
Graduate Program in Gynecologic Oncology at the University Federal das Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul, Brazil.
Gynecol Oncol. 2025 Feb;193:105-112. doi: 10.1016/j.ygyno.2025.01.003. Epub 2025 Jan 11.
To evaluate the efficacy of actinomycin D (ActD) as prophylactic chemotherapy (P-chem) in patients with high-risk complete hydatidiform mole (Hr-CHM) on progression to gestational trophoblastic neoplasia (GTN).
From 1996 to 2023, 426 Hr-CHMs were selected in a cohort of 1623 patients with gestational trophoblastic disease (GTD). From 1996 to 2023, 290 patients with Hr-CHMs received a single bolus dose of Act-D at the time of uterine evacuation (Hr-CHM P-chem group); 136 with the same risk factors did not receive P-chem (Hr-CHM control group). The variables assessed in post-molar GTN were incidence and morbidity considering hCG serum level at diagnosis, relapse frequency, hysterectomy rates.
Post-molar GTN was diagnosed in 19 % of the patients with Hr-CHM P-Chem (55/290) and in 39.7 % of the patients in the Hr-CHM control group (54/136) (P < 0.001). The relative risk of developing post-molar GTN decreased by 52 % (RR = 0.48; 95 % CI: 0.35-0.66; P < 0.001), with a number needed to treat (NNT) of 5. Patients in the P-chem group had a lower hCG serum level (P = 0.007), lower risk of recurrence (P = 0.001) and lower risk of hysterectomy (P = 0.04), with no effect on time to GTN diagnosis (P = 0.09), first line chemotherapy response (P = 0.50) and time to remission (P = 0.72).
A single bolus dose of Act-D (1.25 mg/m2) given as P-chem during uterine evacuation in patients with Hr-CHM may safely prevent the incidence of post-molar GTN and reduce the morbidity associated with GTN. This prophylactic approach can be adopted at any trophoblastic disease center (TDC).
评估放线菌素D（ActD）作为预防性化疗（P-chem）对高危完全性葡萄胎（Hr-CHM）患者进展为妊娠滋养细胞肿瘤（GTN）的疗效。
1996年至2023年，在1623例妊娠滋养细胞疾病（GTD）患者队列中选取426例Hr-CHM患者。1996年至2023年，290例Hr-CHM患者在子宫排空时接受单次大剂量Act-D治疗（Hr-CHM P-chem组）；136例具有相同危险因素的患者未接受P-chem治疗（Hr-CHM对照组）。在葡萄胎后GTN中评估的变量包括根据诊断时的血清hCG水平计算的发病率和发病情况、复发频率、子宫切除率。
Hr-CHM P-Chem组19%（55/290）的患者被诊断为葡萄胎后GTN，Hr-CHM对照组39.7%（54/136）的患者被诊断为葡萄胎后GTN（P<0.001）。发生葡萄胎后GTN的相对风险降低了52%（RR=0.48；95%CI：0.35-0.66；P<0.001），需治疗人数（NNT）为5。P-chem组患者的血清hCG水平较低（P=0.007），复发风险较低（P=0.001），子宫切除风险较低（P=0.04），对GTN诊断时间（P=0.09）、一线化疗反应（P=0.50）和缓解时间（P=0.72）无影响。
Hr-CHM患者在子宫排空时给予单次大剂量Act-D（1.25mg/m²）作为P-chem，可安全预防葡萄胎后GTN的发生，并降低与GTN相关的发病率。这种预防性方法可在任何滋养细胞疾病中心（TDC）采用。
