依托泊苷+甲氨蝶呤+放线菌素D/环磷酰胺+长春新碱为初始方案治疗高危型妊娠滋养细胞肿瘤的疗效及相关因素分析

Curative effects and influenced factors of EMA-CO as an initial regimen for the treatment of high-risk gestational trophoblastic neoplasia

目的旨在分析依托泊苷+甲氨蝶呤+放线菌素D/环磷酰胺+长春新碱(EMA-CO)方案初始化疗对高危型妊娠滋养细胞肿瘤(GTN)患者的疗效及相关因素分析。方法收集浙江大学医学院附属妇产科医院2007年1月至2017年1月收治的81例高危型GTN患者,根据国际妇产科联盟(FIGO)的预后评分,81例患者评分均≥7分,所有患者初始化疗方案为EMA-CO,对其临床特点及其疗效进行单因素和多因素分析。结果81例患者中55例(67.90%)经单纯EMA-CO化疗后达到完全缓解,12例(14.81%)经EMA-CO联合手术达到完全缓解。14例(17.28%)出现耐药。单因素(P=0.002)与多因素分析(P=0.004,OR 1.336,95%CI 1.099~1.623)均显示FIGO预后评分≥12分是EMA-CO耐药的独立影响因素。结论EMA-CO是高危型GTN患者有效的联合化疗方案,对EMA-CO耐药的GTN患者,补救性治疗如足叶乙甙+甲氨蝶呤+放线菌素D/足叶乙甙+顺铂(EMA-EP)联合化疗或手术仍然是有效的治疗方式。FIGO预后评分是EMA-CO耐药的独立影响因素。

Objective This study aims to evaluate the efficacy of EMA-CO as an initial regimen for high-risk gestational trophoblastic neoplasia and to analysis the influenced factors .Methods A total of 81 patients with high-risk gestational trophoblastic neoplasia ( HRGTN) treated in Women Hospital Affiliated Zhejiang University from Jan 2007 to Jan 2017 whose primary chemotherapies were EMA-CO were enrolled.The International Federation of Gynecology and Obstetrics ( FIGO ) prognosis score of all the patients was ≥7.The relationships of different factors were analyzed by univariate and multivariate analysis.Results Fifty-five of 81 patients ( 67.90%) achieved complete primary remission with single EMA-CO regimen, 12 patients (14.81%) achieved complete primary remission with EMA-CO regimen and surgery, and 14 patients (17.28%) achieved drug resistance.The univariate and multivariate analysis showed that the FIGO score (P=0.004, OR 1.336, 95%CI 1.099-1.623) was an independent predictive factor for the outcome of EMA-CO regimen.Conclusions EMA-CO is the first-line regimen used to treat patients with HRGTN.Salvage therapies such as EMA-EP regimen and adjuvant surgery are still effective treatments.The FIGO score is an independent risk factors for the outcome of EMA-CO regimen.