化疗联合甲羟孕酮治疗侵蚀性葡萄胎与绒毛膜癌的疗效观察

Clinical Study of Patients with Invasive Mole and Choriocarcinoma Treated with Chemotherapy and Medroxyprogesterone Acetate in Combination

目的观察化学治疗(化疗)加用甲羟孕酮(MPA)治疗侵蚀性葡萄胎及绒毛膜癌(绒癌)患者的临床疗效。方法侵蚀性葡萄胎及绒癌患者25例,进行自身对照。按常规方法应用氟尿嘧啶、更生霉素8 d疗程,第1疗程不用MPA为对照组,第2疗程开始前1周加用MPA 200 mg.d-1口服为试验组;远期10例Ⅲ期为远期组(未用MPA),近期10例Ⅲ期为近期组(加用MPA)。观察化疗前后两组食欲、恶心、呕吐、口腔溃疡等情况;两组化疗前后白细胞变化及细胞因子白细胞介素-6(IL-6)的变化;比较近期组和远期组化疗疗程数及肺转移结局。结果试验组食欲、恶心、呕吐、口腔溃疡等明显好于对照组(P<0.01);试验组化疗前后白细胞无明显变化(P>0.05),对照组化疗后白细胞明显下降(P<0.01);试验组细胞因子IL-6明显低于对照组(P<0.01);近期组化疗疗程数明显低于远期组,肺转移灶消失时间短于远期组(P<0.01)。结论MPA降低了细胞因子IL-6血清水平,改善了肿瘤化疗患者的生活质量;保护骨髓免于化疗毒性作用,增加了患者对化疗的耐受性;MPA良好的临床作用与其抑制肿瘤新生血管作用有关。

Objective To observe the effect of using medroxyprogesterone acetate （MPA） in a dose of 200 mg·d^-1 for patients with invasive mole and choriocarcinoma during chemotherapy（CT）. Methods Twenty-five patients （2000-2005） were self-compared; 10 stage-Ⅲ patients （1990-1999） were set as the former group, 10 stage-Ⅲ patients in the 25 patients were set as the recent group. Two groups were retrospectively compared and analyzed. The patients were generally treated with 8-days-period treatment of 5-Fu and KSM. Those patients without MPA at their first period of treatment were assigned to control group. Those patients treated with MPA a week before their second period of treatment were assigned to study group. The former group and the recent group respectively were assigned to control group （without MPA） and study group （with MPA）. Appetite, nausea, vomiting, stomatocace and the changes in leukocyte and interleukin-6（IL-6） were evaluated. The numbers of CT and outcome of metastatic foci in lung were compared between the former group and the recent group. Results Appetite, nausea, vomiting and stomatocace in study group were significantly reduced than those in control group （P 〈 0.01）. In study group, after receiving CT there were no significant difference of leukocyte than before （P 〉 0.05）. In control group after receiving CT leukocytopenia was significant （P 〈 0.01）; Serum levels of IL-6 in study group were significantly lower than those in control group （P 〈 0.01）. The number of receiving CT in the recent group was less than that in the former group and the metastatic foci in lung in the recent group disappeared faster than those in the former group （P 〈 0.01）. Conclusions MPA can reduce the serum level of IL-6 and improve the life quality of patients with cancer. MPA can protect bone marrow of the patients from the inhibition by CT, and improve the tolerance to CT. The good clinic effect of MPA may be related to its anti-angiogenesis in tumor.