妊娠滋养细胞肿瘤46例临床分析

目的:分析妊娠滋养细胞肿瘤的临床特点及诊治经验,探讨其临床各期的治疗。方法:收集我院2000年1月至2007年6月收治的妊娠滋养细胞肿瘤46例患者的临床资料,分析其病史特点、发病规律、经化疗或化疗联合手术治疗后的临床转归。结果:46例中放弃治疗2例,44例患者经化疗或化疗结合手术治疗后完全恢复。其中绒毛膜癌11例,完全恢复11例,治愈7例,治愈率63.64%;侵蚀性葡萄胎33例,完全恢复33例,治愈22例,治愈率66.67%。结论:化疗是妊娠滋养细胞肿瘤主要的治疗方法。对有转移瘤破裂出血、不能确定诊断或对化疗耐药的患者,配合适当的手术治疗,疗效更佳。     

恶性滋养细胞肿瘤保留生育功能的手术治疗

恶性滋养细胞肿瘤多发于育龄妇女。自５０年代首先证实大剂量氨甲喋呤能有效治疗恶性滋养细胞肿瘤及随后发现一系列有效化疗药物后，恶性滋养细胞肿瘤的治愈率已达８０％～９０％。许多年轻妇女可通过化疗治愈而保留生育机能。宋鸿钊等报道通过单纯化疗治愈有生育要求的２...     

化疗联合手术治疗高危型妊娠滋养细胞肿瘤25例分析

目的:分析高危型妊娠滋养细胞肿瘤治疗中手术的重要性。方法:收集我院自2000年1月～2010年8月间收治的高危型妊娠滋养细胞肿瘤患者的临床资料,分析其临床特点及手术联合化疗的临床转归。结果:25例中13例行次广泛子宫切除加双附件切除,2例行全子宫切除,其余10例分别行子宫病灶切除或子宫外转移灶切除术,除2例自动出院失访外,23例均获完全缓解,临床缓解率92%,平均化疗疗程5.8个。结论:在高危型妊娠滋养细胞肿瘤中应用强有力化疗的同时正确选择手术可有效地控制病情,减少化疗疗程,降低化疗副反应,提高治愈率。     

BEP方案治疗恶性滋养细胞肿瘤38例临床分析

目的 研究BEP方案治疗妊娠恶性滋养细胞肿瘤的疗效及化疗副反应。方法 1997年1月～2005年8月，采用BEP方案治疗妊娠恶性滋养细胞肿瘤38例，其中初治患者20例，耐药患者15例，复发患者3例。结果 该方案治疗38例妊娠恶性滋养细胞肿瘤患者，36例完全缓解，总完全缓解率为89．47％。其中初治侵蚀性葡萄胎的治愈率为100％，耐药绒癌的完全缓解率为92．31％，复发性妊娠恶性滋养细胞肿瘤的完全缓解率为100％。化疗副反应主要为Ⅰ～Ⅱ级恶心、呕吐和骨髓抑制。结论 采用BEP方案治疗妊娠恶性滋养细胞肿瘤疗效可，对其他药物耐药或复发病例也可获得满意的疗效，化疗副反应轻，患者易接受，值得进一步研究。     

长春新碱卡铂甲氨蝶呤联合治疗滋养细胞肿瘤76例疗效分析

目的 观察长春新碱（VCR）、卡铂（CBP）、甲氨蝶呤（MTX）联合治疗滋养细胞肿瘤的疗效及毒副反应。方法 分析76例初治滋养细胞肿瘤患者，采用VCR、CBP、MTX联合化疗的近期疗效、毒副反应及随访结果。结果 76例经治疗后全部治愈，近期临床治愈率为100％，其hCG降至正常或达近期临床治愈所需的平均疗程数分别为1．92个和2．71个；经随访复发率为1．3％（1／76），48例保留生育功能者已获妊娠30例次，妊娠废胎率为10．0％；主要的毒副反应为骨髓抑制，而消化道反应较轻。结论 VCR、CBP、MTX联合治疗滋养细胞肿瘤，具有疗效好，显效快，毒副反应轻等优点，是理想的联合化疗方案之一。     

5－氟尿嘧啶联合消瘤芥治疗恶性滋养细胞肿瘤的疗效评价

目的：评价５－氟尿嘧啶联合消瘤芥治疗恶性滋养细胞肿瘤的疗效。方法：回顾性分析辽宁省肿瘤医院自１９７９年至１９８８年以５－氟尿嘧啶（５－ＦＵ）与消瘤芥（ＡＴ１２５８）联合用药治疗的１６６例恶性滋养细胞肿瘤患者的近期疗效、副反应及长期随访结果。结果：１３６例侵蚀性葡萄胎中１０９例（８０．１％）及３０例绒癌中２５例（８３．３％）单纯以本方案治愈。本组侵蚀性葡萄胎近期治愈率为１００．０％，５年及１０年累计生存率为１００．０％及９９．３％。绒癌近期治愈率为８６．７％，５年及１０年累计生存率均为８５．８％。本组无一例因化疗副反应或其并发症死亡。结论：５－ＦＵ与ＡＴ１２５８联合用药是治疗恶性滋养细胞肿瘤的有效化疗方案。     

35例恶性滋养细胞肿瘤脑转移的临床转归

目的探讨恶性滋养细胞肿瘤脑转移的临床特点、治疗方法、预后影响因素及临床转归。方法回顾性分析486例恶性滋养细胞肿瘤中发生脑转移的35例患者的临床资料。除8例未及时治疗死亡外,其余27例均接受多药联合的全身及局部化疗3～12个疗程,20例进行了脱水降颅内压治疗,其中4例行急诊开颅手术。结果脑转移的发生率为7.2%。27例经正规治疗后的缓解率为81.4%。脑栓期、脑瘤期和脑疝期的死亡率分别为12.5%、31.8%及100%。发生脑转移时未曾化疗、曾行化疗和耐药患者的缓解率分别为81.3%、60.0%和0。结论恶性滋养细胞肿瘤脑转移预后较差,重视脑转移的临床特点及早期诊断是改善预后的关键,曾否接受过化疗是影响其临床转归的重要因素,多药联合全身和局部兼顾化疗加应急措施是治疗的主要手段。     

低危妊娠滋养细胞肿瘤化疗现状及耐药发生相关因素北大核心CSCD

妊娠滋养细胞肿瘤（GTN）已经成为目前治愈率最高的实体瘤,在存在广泛转移的情况下,仍可获得高于90％的治愈率。而低危GTN的5年总生存率则几乎达到了100％。本文将重点对低危GTN的化疗现状及其耐药相关的危险因素进行分析。1 低危妊娠滋养细胞肿瘤的定义 2000年之前主要依据世界卫生组织（WHO）的GTN预后评分进行分层、制定化疗方案及预测治疗的有效性。     

高危及耐药性妊娠滋养细胞肿瘤患者的治疗策略

妊娠滋养细胞肿瘤(GTN)是一组来源于胎盘滋养细胞异常增殖的肿瘤,包括侵蚀性葡萄胎、绒毛膜癌、胎盘部位滋养细胞肿瘤(PSTT)和上皮样滋养细胞肿瘤(ETT)。GTN是一类对化疗高度敏感的肿瘤,自发现有效化疗药物以来,其治愈率可达98%,其中低危GTN患者的治愈率近100%,而高危患者的治愈率为80%~90%。高危患者的临床异质性较大,部分患者对化疗耐药,病情凶险,处理棘手。因此,本文将对高危及耐药性GTN患者的治疗策略做一综述。     

妊娠滋养细胞肿瘤治疗中的过度与不足

妊娠滋养细胞肿瘤(GTN)包括侵蚀性葡萄胎、绒毛膜癌、胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤,虽然总体治愈率达90%以上,但治疗不当的问题仍然存在。文章从化疗方案的选择、化疗副反应的处理、停止化疗的时机、手术的指征及价值等几方面阐述在临床上存在的对GTN患者治疗的过度与不足。     

Management of high-risk hydatidiform mole and persistent gestational trophoblastic neoplasia: the Korean experience

OBJECTIVE: To test the efficacy of a new scoring system to differentiate high-risk hydatidiform mole (H-mole) and initiate early selective postmolar chemotherapy. STUDY DESIGN: According to Kim's scoring system, 262 patients were identified as high-risk H-mole patients. Fifty (19.1%) received early chemotherapy, and the rest constituted the control group. Salvage therapy with etoposide, methotrexate, actinomycin D/etoposide, cisplatin (EMA/EP) and taxol, cisplatin/taxol, etoposide (TP/TE) was applied in 21 cases of ultra-high-risk GTT. RESULTS: None of the 50 cases in the early chemotherapy group progressed to persistent GTT. However, 58.9% in the control group developed GTT with 8.0% drug resistance. Of those receiving salvage therapy in the 21 ultra-high-risk GTT cases resistant to EMA/CO, 10 of 14 (71%) receiving EMA/EP and 4 of 7 (57.1%) receiving TP/TE achieved remission. CONCLUSION: Early postmolar chemotherapy for high-risk H-mole is effective in preventing progression to persistent GTT and treatment failure. Ultra-high-risk GTT should be approached with multimodal treatment, including EMA/EP and TP/TE regimens.     

Management of low-risk metastatic gestational trophoblastic tumors.

The clinical course of 48 patients with low-risk metastatic gestational trophoblastic tumors (GTTs) treated with primary single-agent chemotherapy was reviewed. All patients achieved sustained remission, although 25 (51%) required a second single-agent regimen, and 7 (14%) needed combination chemotherapy to achieve it. An average of 3.4 courses of chemotherapy were necessary to achieve remission, and 6 patients (12%) underwent resection of resistant tumor foci. Primary single-agent chemotherapy is a reasonable treatment option in patients with low-risk metastatic GTT.     

Risk of abnormal pregnancy completing chemotherapy for gestational trophoblastic tumor

OBJECTIVE: This study analyzed the outcome of the first pregnancy following chemotherapy for gestational trophoblastic tumor (GTT). METHODS: A total of 387 patients with GTT (85 patients with high-risk GTT and 302 patients with low-risk GTT) underwent chemotherapy at Chiba University Hospital between 1974 and 2000. Of these patients, 130 women (18 with high-risk GTT and 112 with low-risk GTT), who achieved remission and had at least one conception following chemotherapy, were included in the study. RESULTS: The outcomes of all the first subsequent pregnancies in women treated with methotrexate, actinomycin-D, or etoposide (including those switched to other regimens), or combination therapy, were comparable to those in the Japanese general population. However, the incidence of abnormal pregnancies (spontaneous abortion, still birth, repeat mole) was significantly higher in women who conceived within 6 months of completing chemotherapy (4/15; 40%) than in those who conceived after the recommended waiting period of more than 12 months (10/95; 10.5%) (P = 0.028). CONCLUSION: Patients with GTT who achieved remission after chemotherapy with methotrexate, actinomycin-D, or etoposide, or combination therapy, may anticipate a normal future reproductive outcome. As pregnancies occurring within 6 months following remission are at risk of abnormalities, a waiting period of at least 6 months after chemotherapy for GTT is suggested.     

Management of patients with metastatic gestational trophoblastic tumor

OBJECTIVE: This study was designed to analyze the results of treatment on patients with metastatic gestational trophoblastic tumor (metastatic GTT). METHOD: During 1996-2001, 38 cases with metastatic GTT were diagnosed and received treatment in Vali-e-Asr Hospital, Tehran, Iran. Data were gathered retrospectively and analyzed based on therapy and response rate. Sixteen patients initially labeled as low-risk, four as middle-risk and eighteen as high-risk patients according to FIGO scoring system (1992). Thirty-four (89.5%) patients responded to treatment; 13 to single-agent [methotrexate (MTX) or ACT] and 21 to multiagent chemotherapy [EMA/cisplatinum and etoposide (EMA-EP) or MTX, ACT-D and cyclophosphamide or chlorambucil (MAC)]. RESULTS: All low-risk patients, 2 middle-risk patients and 16 high-risk patients responded to treatment. Four cases failed to respond to therapy due to CNS involvement. CONCLUSIONS: Patients with low-risk metastatic GTT have a 100% chance to response to single-agent chemotherapy and those with high-risk disease have great chance to response to multiagent chemotherapy such as EMA-EP.     

Recurrent gestational trophoblastic tumor: management and risk factors for recurrence

OBJECTIVE: To analyze retrospectively the management of recurrent gestational trophoblastic tumor (GTT) patients and evaluate the recurrence associated risk factors. METHOD: 901 gestational trophoblastic tumor (GTT) patients who received treatment at Peking Union Medical College Hospital from January 1985 to January 2004 achieved complete remission (CR). Among them, thirty-one (31/901) relapsed later. Retrospective analyses were carried out on the 31 patients, and multiple regression models were used to identify the risk factors for recurrence. RESULTS: In all 31 patients, recurrences occurred 6 to 72 months (15.3 months on average) after completing treatment. Of the 25 patients who received treatment again in our hospital, 21 achieved CR, 3 achieved partial remission (PR), and 1 died of progression of disease (PD). Among the 21 CR patients, 4 relapsed repeatedly. The four recurrence associated risk factors identified by multivariate analysis were clinical stage (P<0.05), an interval of more than 12 months between the end of antecedent pregnancy and the start of chemotherapy (odds ratio=3.170, P<0.05), a negative blood beta-hCG titer after seven courses of chemotherapy (odds ratio=4.475, P<0.05), and a less than two courses of consolidation chemotherapy (odds ratio=0.441, P<0.05). CONCLUSION: More attention should be given to GTT patients with recurrence associated risk factors. Combination therapy for GTT treatment is effective. In the study, it was demonstrated that certain risk factors were associated with relapse. These factors may need to be integrated into treatment algorithms.     

Evolution of treatment of high-risk metastatic gestational trophoblastic tumors: Ain Shams University experience

The aim of the current study is to evaluate the different treatment modalities used in the management of high-risk metastatic gestational trophoblastic tumors (GTT) between June 1992 and December 2004 at the Gynecologic Oncology Unit, Ain Shams University. Out of 261 patients diagnosed and treated for GTT, 70 (26.8%) were high risk metastatic patients based on the National Institutes of Health clinical classification. The mean age was 29.39 +/- 9.38 years (16-55 years), with six patients (8.6%) being older than 39 years, and the mean duration of follow-up was 79.74 +/- 40.44 months (6-157 months). Forty patients (57.14%) were diagnosed after molar pregnancy, 22 (31.43%) after abortion, and 8 (11.43%) after term pregnancy. Forty-two patients (60%) were diagnosed within 4 months of the occurrence of the disease, and 28 (40%) were diagnosed after more than 4 months. Sixty-seven patients were treated using different regimens according to the protocol of treatment at that time. The MAC regimen was used initially but has been subsequently abandoned in favor of EMA-CO (etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine [Oncovin]) regimen, which was later modified by omitting the CO arm to decrease its toxicity. If resistance developed, platinum-based therapy was given in the form of EMA-EP. Recently, our unit incorporated paclitaxel in the third-line treatment. Surgical intervention was used selectively. Fifty-seven (81.4%) patients could be cured; 43 by initial chemotherapy, with a mean of 7 +/- 0.46 courses (6-15), and 14 were salvaged by second- or third-line chemotherapy. Fourteen patients (20%) died during the study period; one was unrelated to GTT, while three died of acute respiratory distress syndrome before instituting proper therapy and two died of treatment complications. Using univariate and multivariate Cox regression analyses, the presence of brain and/or liver metastases was found to be the worst prognostic variable affecting the survival, followed by resistance to combination chemotherapy and then the type of antecedent pregnancy. The projected 5-year survival as estimated by Kaplan-Meier method was 78%.     

Early pregnancy outcomes after chemotherapy for gestational trophoblastic tumor

OBJECTIVE: To analyze the outcome of the first pregnancy following chemotherapy for gestational trophoblastic tumor (GTT). STUDY DESIGN: A total of 393 patients with GTT (87 with high-risk and 306 with low-risk GTT) underwent chemotherapy at Chiba University Hospital between 1974 and 2000. Of them, 137 (19 with high-risk and 118 with low-risk GTT) who achieved primary remission and had at least 1 conception following chemotherapy were included in the study. RESULTS: The overall outcomes of the first subsequent pregnancies in the 137 women treated with chemotherapy were comparable to those in the general Japanese population. However, the incidence of abnormal pregnancies (spontaneous abortion, stillbirth, repeat mole) was significantly higher in women who conceived within 6 months of completing chemotherapy (6 of 16, 37.5%) than in those who conceived after the recommended waiting period, > 12 months (11 of 99, 10.5%) (P=.014). CONCLUSION: Patients who achieved primary remission with various kinds of chemotherapy may anticipate a normal future reproductive outcome. As pregnancies occurring within 6 months following remission are at risk of abnormality, a waiting period of at least 6 months after chemotherapy for GTT is recommended.     

Persistent gestational trophoblastic tumor after partial hydatidiform mole

The current study investigates the clinical characteristics of patients with partial molar pregnancy who developed persistent gestational trophoblastic tumor (GTT). Between January 1979 and January 1989, 16 of 240 (6.6%) patients, who were followed for partial mole, developed persistent GTT. Fifteen (94%) patients were diagnosed as having a missed abortion before evacuation and only 1 patient presented with excessive uterine size and theca lutein ovarian cysts and was felt to have molar disease. No patient presented with toxemia, hyperemesis, or hyperthyroidism. All 16 patients developed nonmetastatic GTT. Fifteen patients achieved complete remission with methotrexate-citrovorum factor and only 1 patient required combination chemotherapy to attain remission. None of the patients had histologic evidence of choriocarcinoma. Patients with partial mole who developed persistent GTT did not have clinical or pathological characteristics that distinguished them from other patients with partial mole. All patients with partial mole should be followed with measurement of hCG levels to assure gonadotropin remission.     

妊娠滋养细胞肿瘤膀胱转移的诊断和治疗

目的 评估妊娠滋养细胞肿瘤膀胱转移患者的治疗方法及临床预后。方法 回顾性分析1988～1999年收治的滋养细胞肿瘤(GTT)膀胱转移患者共10例。所有患者均接受了以5-氟脲嘧啶(5-Fu)为主的联合化疗或EMA/CO化疗,同时行5-Fu膀胱灌注。部分患者选择性动脉插管行子宫动脉、膀胱上动脉及髂内动脉栓塞以控制大出血。通过监测β-hCG水平、B超、CT、膀胱镜等辅助检查措施以判断治疗效果。结果10例中2例合并脑转移死亡。1例血生化指标缓解,带瘤存活;7例治愈,其中1例治愈后即失访,6例随诊11-36个月,无复发迹象。结论 滋养细胞肿瘤膀胱转移患者经过正规的全身加局部化疗,疗效较好。选择性动脉插管栓塞可以作为急诊处理膀胱转移大出血患者的首选方法。     

FAEV化疗方案治疗高危型耐药性妊娠滋养细胞肿瘤的疗效分析

目的 总结分析氟尿苷＋放线菌素D＋依托泊苷＋长春新碱（FAEV）化疗方案治疗高危型耐药性妊娠滋养细胞肿瘤的疗效。方法 2001年10月至2004年5月,北京协和医院使用FAEV方案治疗高危型耐药性妊娠滋养细胞肿瘤患者共11例,根据国际妇产科联盟（FIGO）预后评分系统（2000年）评分为7—13分（中位数为9分）,所有患者均因对其他化疗方案耐药而改用FAEV方案,随诊时间15—42个月。结果 以FAEV方案治愈7例患者（64％,7／11）;对FAEV方案耐药4例（36％,4／11）,其中2例改用其他化疗方案后获得缓解,2例放弃治疗。11例患者共接受FAEV方案化疗64个疗程,FAEV方案的主要毒副反应为骨髓抑制,需使用粒细胞集落刺激因子的疗程f与98％（63／64）。结论 对于高危型耐药性妊娠滋养细胞肿瘤患者,FAEV化疗方案可作为一种治疗选择。