化疗联合手术治疗耐药性妊娠滋养细胞肿瘤的临床分析

Clinical analysis of chemotherapy combined with surgery for drug-resistant gestational trophoblastic tumors

目的探究化疗联合手术治疗耐药性妊娠滋养细胞肿瘤(Gestational trophoblastic neoplasia,GTN)患者的临床效果。方法选择耐药的高危型GTN患者76例,随机分为对照组和研究组,各38例;对照组使用足叶乙甙+甲氨蝶呤+放线菌素D/足叶乙甙,顺铂(etoposide,methotrexate,and actinomycin-D/etoposide and cisplatin,EMA/EP)方案化疗,研究组使用化疗联合手术治疗的方法治疗;比较两组的治疗效果、预后、外周血林白细胞亚群以及不良反应发生情况。结果治疗6个月后研究组的客观缓解率(Objective response rate,ORR)高于对照组,差异具有统计学意义(P=0.024);研究组的耐药率和复发率低于对照组(P<0.05);治疗前两组血清人绒毛膜促性腺激素(Human chorionic gonadotropin,HCG)差异无统计学意义,治疗后两组HCG水平均降低(P<0.001),治疗后6个月、12个月和末次随访研究组的血清HCG水平低于对照组(P<0.001);治疗前两组外周血T细胞亚群水平差异无统计学意义,而治疗6个月后均有不同程度的改善;研究组的CD3^+、CD4^+和CD4^+/CD8^+T细胞高于对照组(P<0.001);研究组的中性粒细胞减少、血红蛋白降低、恶心呕吐、脱发的发生率则低于对照组(P<0.05)。结论对于一线耐药的高危GTN患者,化疗联合手术治疗具有更好的治疗效果,并可有效改善机体免疫水平,降低不良反应的发生。

Objective The objective of this study was to explore the clinical effects of chemotherapy combined with surgery in patients with drug-resistant gestational trophoblastic neoplasia(GTN).Methods A total of 76 drug-resistant patients with high-risk GTN were selected and randomly divided into a control group and an observed group,each with 38 patients.Patients in the control group were treated with etoposide,methotrexate,and actinomycin-D/etoposide and cisplatin(EMA/EP),and patients in the observed group were treated with EMA/EP regimen combined with surgery.The treatment effect,prognosis,peripheral blood lymphocyte subsets and adverse reactions were compared between the control and observed groups.Results After 6 months of treatment,the ORR(objective response rate)of the observed group was higher than that of the control group,and the difference was statistically significant(P=0.024).The drug resistance rate and recurrence rate in the observed group were lower than those in the control group(P<0.05).There was no significant difference in serum HCG between the control and observed groups before treatment.The serum HCG levels in two groups decreased after treatment(P<0.001).The serum HCG levels in the observed group at 6 months,12 months,and the last follow-up after treatment were lower than those in the control group(P<0.001).There was no significant difference in the levels of T lymphocyte subsets between the two groups before treatment,and there were different degrees of improvement after 6 months of treatment.The CD3^+,CD4^+and CD4^+/CD8^+T cells in the observed group were higher than those in the control group(P<0.05).The incidence of neutropenia,hemoglobin reduction,nausea and vomiting,and hair loss in the observed group were lower than those in the control group(P<0.05).Conclusion For patients with high-risk GTN in first-line drug-resistance,chemotherapy combined with surgery has a better therapeutic effect,and can effectively improve the body′s immune level and reduce the incidence of adverse reactions.