Ngan Hextan Y S, Seckl Michael J, Berkowitz Ross S, Xiang Yang, Golfier François, Sekharan Paradan K, Braga Antonio, Garrett Andrea
Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Department of Medical Oncology, Charing Cross Trophoblastic Disease Center, Charing Cross Campus of Imperial College London, London, UK.
Int J Gynaecol Obstet. 2025 Sep;171 Suppl 1:78-86. doi: 10.1002/ijgo.70275. Epub 2025 Jul 9.
Gestational trophoblastic disease (GTD) arises from abnormal placenta and comprises a spectrum of premalignant to malignant disorders. Changes in the epidemiology of GTD have been noted in various countries. In addition to histology, molecular genetic studies can help in the diagnostic pathway. Earlier detection of molar pregnancy by ultrasound has resulted in changes in clinical presentation and decreased morbidity from uterine evacuation. Follow-up with human chorionic gonadotropin (hCG) is essential for early diagnosis of gestational trophoblastic neoplasia (GTN). The duration of hCG monitoring varies depending on histological type and regression rate. Low-risk GTN (International Federation of Gynecology and Obstetrics [FIGO] Stages I-III: score <7) is treated with single-agent chemotherapy but may require additional agents. Although scores of 5-6 are associated with higher drug resistance, overall survival approaches 100%. High-risk GTN (FIGO Stages II-III: score ≥7 and Stage IV) is treated with multi-agent chemotherapy, with or without adjuvant surgery for excision of resistant foci of disease or radiotherapy for brain metastases, achieving a survival rate of approximately 90%. Gentle induction chemotherapy in ultra-high-risk disease helps reduce early deaths in patients with extensive tumor burden, but late mortality still occurs from recurrent treatment-resistant tumors. Immunotherapy can be considered in recurrence.
妊娠滋养细胞疾病（GTD）起源于异常胎盘，包括一系列从癌前病变到恶性病变的疾病。不同国家已注意到GTD流行病学的变化。除了组织学检查外，分子遗传学研究有助于诊断过程。超声对葡萄胎的早期检测导致了临床表现的改变，并降低了子宫排空的发病率。人绒毛膜促性腺激素（hCG）随访对于妊娠滋养细胞肿瘤（GTN）的早期诊断至关重要。hCG监测的持续时间因组织学类型和消退率而异。低风险GTN（国际妇产科联合会[FIGO]分期I - III：评分<7）采用单药化疗，但可能需要加用其他药物。虽然评分5 - 6与较高的耐药性相关，但总体生存率接近100%。高风险GTN（FIGO分期II - III：评分≥7和IV期）采用多药化疗，可联合或不联合辅助手术切除耐药病灶或对脑转移进行放疗，生存率约为90%。超高风险疾病采用温和诱导化疗有助于降低肿瘤负荷广泛患者的早期死亡，但复发的耐药肿瘤仍会导致晚期死亡。复发时可考虑免疫治疗。
