极高危妊娠滋养细胞肿瘤的治疗策略

Therapeutic Strategies of Ultra High-Risk Gestational Trophoblastic Neoplasms

妊娠滋养细胞肿瘤(GTN)是一类对化疗极敏感的恶性肿瘤,主要的治疗策略包括全身化疗和对转移瘤的处理。低危患者的总体生存率接近100%,而高危患者的总体生存率为80%～90%。国际妇产科联盟(FIGO)预后评分≥12分或存在肝、脑转移或广泛转移的患者被定义为极高危患者。极高危患者治疗效果差,死亡率高。主要原因有广泛的耐药病灶,肺部病灶进展导致呼吸衰竭以及脑、肝转移灶出血。极高危GTN患者的治疗策略以联合化疗为主,辅以手术、放疗或介入治疗等。当遇到病情严重的极高危患者时,应尽早诊断,稳定患者病情,并建议转诊至有综合诊治能力的妊娠滋养细胞疾病中心。现就极高危GTN患者的治疗策略进行综述。

Gestational trophoblastic neoplasms(GTN)is a series of malignant tumor that is extremely sensitive to chemotherapy.The main therapeutic strategies include systemic chemotherapy and the treatment of metastatic tumors.The overall survival(OS)rate almost approaches 100%in low-risk patients,whereas high-risk patients can achieve a overall survival rate of 80%~90%.Patients with the FIGO prognosis score≥12 points or those with liver,brain metastases,or extensive metastases were defined as ultra high-risk patients.Prognosis of ultra high-risk patients has been poor,and mortality rate has been high.The main reasons include widespread chemotherapy-resistant disease,respiratory failure due to progressive disease in the lungs or hemorrhage from brain and liver metastases.The therapeutic strategies for ultra high-risk GTN patients are treated primarily with combined chemotherapy,supplemented by surgery,radiotherapy or interventional therapy.It is recommended to diagnose as soon as possible and stable patient′s condition when faced with extremely serious ultra high-risk GTN patients,also referral to the gestational trophoblastic disease centres which have a comprehensive diagnosis and treatment capability.The research progress of treatment strategies for ultra high-risk GTN was discussed in this review.