甲氨蝶呤单药治疗低危妊娠滋养细胞肿瘤的疗效

Single Methotrexate Chemotherapy for Low-risk Gestational Trophoblastic Tumor

目的探讨甲氨蝶呤(MTX)单药治疗低危妊娠滋养细胞肿瘤的疗效和安全性。方法本院1999年10月～2002年9月共37例低危妊娠滋养细胞肿瘤患者接受MTX单药治疗,收集其临床资料,并统计患者年龄、临床分期、WHO评分、先前妊娠、治疗前血清人绒毛膜促性腺激素(hCG)水平、达到完全缓解所需要的化疗疗程和治疗期间毒副反应。结果37例患者共接受137疗程MTX单药化疗,34例达到完全缓解,完全缓解率91.9%。37例患者中29例接受MTX单药多疗程化疗,平均疗程4.4个,完全缓解26例,完全缓解率89.7%;其中Ⅰ期患者19例,均达完全缓解,完全缓解率100%;Ⅲ期患者10例,达完全缓解7例,完全缓解率70.0%,两者比较有显著性差异(P=0.03)。8例计划给予MTX单药单疗程化疗患者,7例达到完全缓解,1例Ⅲ期患者追加1疗程MTX后达完全缓解。137疗程出现严重毒副反应7疗程,其发生率5.1%。经随访仅1例单疗程化疗患者在化疗结束后6个月复发,完全缓解后复发率2.7%。结论MTX单药治疗低危妊娠滋养细胞肿瘤是安全、有效的,部分患者仅单疗程化疗即可达完全缓解。

To investigate the efficacy and toxicity of methotrexate (MTX)given intravenously in the primary treatment of gestational trophoblastic tumor (GTT).Methods A total of37patients with low-risk GTT was primarily treated by single MTX in Women's Hospital,School of Medicine,Zhejiang University.Data on the patients' age,clinical stage,WHO classification criteria,antecedent pregnancy,presenting level of human chorionic gonadotropin,courses of chemotherapy required to achieve complete remission,and toxicity related to chemotherapy treatments were collected.Results Thirty-seven patients with low-risk GTT totally received137cycles of MTX between Oct.1999and Sep.2002,34patients(91.9%)achieved complete remission.Twenty-nine patients received multiple courses of MTX,complete remission was induced in26patients(89.7%).The complete response rates ofⅠstage andⅢstage were100.0%and70.0%(P=0.03)respectively in patients who were received multiple courses of MTX.However,eight patients received single course of chemotherapy,7patients achieved complete remission,and1achieved complete remission after another additional course of MTX was conducted.GradeⅢside effects(WHO criteria)only appeared in7courses(5.1%)during MTX treatment.Follow-up data showed that only one patient with single course of chemotherapy relapsed after6months.Conclusion Single MTX chemotherapy may be effective and well tolerated for low-risk GTT.