低危妊娠滋养细胞肿瘤单药化疗耐药的高危因素分析

Factor analysis of drug resistance to single drug chemotherapy in low-risk gestational trophoblastic neoplasia

目的:探讨低危妊娠滋养细胞肿瘤(GTN)单药化疗耐药的高危因素。方法:回顾分析2010年6月至2017年12月南京医科大学鼓楼临床学院妇科收治的84例初治低危GTN患者的临床资料。结果:84例低危GTN患者中,15例发生耐药,耐药率为17.9%。继发于葡萄胎和流产患者的耐药率比较,差异无统计学意义(P> 0. 05)。低危GTN患者的单药化疗耐药发生与血清β-HCG值水平高、肿瘤病灶较大、转移病灶较多、FIGO/WHO预后评分较高有关,差异均有统计学意义(P<0.05),而与患者接受MTX为主的化疗单药化疗方案和5-FU为主的单药化疗方案无关。结论:最大肿瘤病灶≥5cm,转移病灶≥5个、血清β-HCG值>105IU/L、FIGO/WHO预后评分6分可能是化疗耐药的高危因素,不同单药化疗方案的耐药率无显著差异。

Objective:To define the high-risk factors of resistance to single-agent chemotherapy in low-risk gestational trophoblastic neoplasia(GTN).Methods:Low-risk GTN patients were reviewed in Gynaecology Department of Nanjing Drum Tower Hospital between Jun.2010 and Dec.2017.Results:Among 84 low-risk GTN patients,15 patients(17.9%)had resistance to single-agent chemotherapy.There was no statistical difference of chemotherapy resistance between patients who had GTN secondary to hydatidiform mole and abortion(P>0.05).Increased resistance was significantly associated with higherβ-HCG level、larger tumor size、more metastatic lesions and higher FIGO/WHO prognostic scores,but was not related to patients receiving MTX-based single-drug chemotherapy or 5-FU based single-drug chemotherapy(P>0.05).Conclusions:Large tumor size(the largest one≥5cm),multiple metastatic lesions(≥5),highβ-HCG level(>10 5IU/L)and high FIGO/WHO prognostic score(6)are high-risk factors associated with chemotherapy resistance in low-risk GTN.Other factors,such as different chemotherapeutic agents,don't have a significant influence on resistance to chemotherapy.