Clinical characteristics and prognosis of ultra high-risk gestational trophoblastic neoplasia patients: A retrospective cohort study

被引:37
作者
Kong Yujia
Yang Junjun
Jiang Fang
Zhao Jun
Ren Tong
Li Jie
Wang Xiaoyu
Feng Fengzhi
Wan Xirun
Xiang Yang [1 ]
机构
[1] Chinese Acad Med Sci, Peking Union Med Coll Hosp, Dept Obstet, 1 Shuaifuyuan, Beijing 100730, Peoples R China
关键词
Gestational trophoblastic neoplasia; Ultra high-risk; Chemotherapy; Survival; Prognosis; ACTINOMYCIN-D; VINCRISTINE CHEMOTHERAPY; ETOPOSIDE; DISEASE; MANAGEMENT; EMA/CO; METHOTREXATE; TUMORS; FAEV; DACTINOMYCIN;
D O I
10.1016/j.ygyno.2017.04.010
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objective. The gestational trophoblastic neoplasia (GTN) patients with the International Federation of Gynecology and Obstetrics (FIGO) score >= 12 are defined as ultra high-risk GTN. This study aims to investigate the clinical characteristics, the treatment efficiency, and the prognosis of ultra high-risk GTN patients. Methods. Between January 2002 and December 2015, medical record data of 143 GTN patients with FIGO score >= 12 at Peking Union Medical College Hospital (PUMCH) were reviewed. Ratios were compared using chi-square test, and prognostic risk factors were analyzed by univariate analysis and multivariate analysis. Results. Among the 143 ultra high-risk GTN patients, 94 (65.7%) patients had achieved complete remission and 15.9% (15/94) patients relapsed after complete remission. The 5-year overall survival (OS) rate of the entire cohort approached 67.9%. The results of the multivariate analysis revealed that non-molar antecedent pregnancy [Relative risk (RR) 4.689, 95% CI 1.448-15.189, P = 0.010], brain metastases (RR 2.280, 95% CI 1.248-4.163, P = 0.007), previous failed multiagent chemotherapy (RR 5.345, 95% CI 2.222-12.857, P = 0.000) and surgery (RR 0336, 95% CI 0.177-0.641, P = 0.001) all had influence on the prognosis of ultra high-risk GTN patients. Conclusions. GTN patients with FIGO score L 12 have a poor prognosis. More emphasis should be placed on non-molar antecedent pregnancy, brain metastases, and previous multiagent chemotherapy failure. Moreover, salvage surgery may improve the prognosis. Floxuridine-based multiagent chemotherapy is effective with manageable toxicity for ultra high-risk GTN patients. (C) 2017 Published by Elsevier Inc.
引用
收藏
页码:81 / 86
页数:6
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