低危型妊娠滋养细胞肿瘤耐药、复发相关因素的研究进展

Progress on Factors Related with Resistance and Relapse in Patients with Low-risk Gestational Trophoblastic Neoplasia

低危型妊娠滋养细胞肿瘤的治愈率几乎100%,但仍有10%~67%的患者对初始化疗耐药,1.3%~8.3%的患者初始化疗后复发,而发生耐药、复发的患者不仅面临着经济上的负担,还承受着身体上的痛苦和精神上的压力。因此,越来越多国内外学者致力于其耐药、复发相关危险因素的探索,以期早期识别甚至预测耐药、复发,从而及早进行临床干预,改善初始化疗效果,降低化疗毒副反应。通过研究取得一定经验：除国际妇产科联盟（FIGO）评分系统中的部分单因素、FIGO综合评分分值、FIGO评分系统以外诸如人绒毛膜促性腺激素（h CG）残留（β-h CG modeled residual production,h CGres）、子宫动脉搏动指数（uterine artery pulsatility index,UAPI）、经阴道超声（transvaginal sonography,TVS）特征性改变、巩固疗程数、病理表现为绒癌、初始化疗药物及方案与耐药、复发关系密切,但仍存在不少谜团。就低危型妊娠滋养细胞肿瘤患者初始化疗后耐药、复发相关因素研究现况进行综述。

Approximately all low-risk gestational trophoblastic neoplasia（LR-GTN） can be cured by chemotherapy.After first single-agent treatment 10 to 67 percent of patients become drug resistant, while 1.3 to 8.3 percent relapse, which not only brings heavy load to their economy, but also casts dark shadow physically and psychologically. Experts from home and abroad have paid more and more attention to this issue, with the expectation of improving prognosis through adequate clinical interventions at an early stage of the disease. Researches have manifested different possible related factors, certain experience been learned, such as some items within the FIGO system, FIGO total score and others including β-h CG modeled residual production（h CGres）, uterine artery pulsatility index（UAPI）, certain image changes of lesions through TVS, choriocacinoma,consolidation course number and drugs and regimens chosen, but they are still controversial. The current knowledge about risk factors associated with resistance and recurrence in LR-GTN cases after initial single chemotherapy was reviewed.