Abstract：
Methotrexate (MTX) is frequently used as first-line treatment for low-risk gestational trophoblastic neoplasia (GTN). Intravenous and intramuscular (im) routes of administration are the most common methods, although oral administration is used by some Scandinavian centers. The primary aim of this study was to assess the impact of form of administration (im/oral) on resistance to methotrexate (MTX-R) treatment in low-risk GTN. Secondary aims were time to hCG normalization, rates of toxicity-induced treatment switch, and rates of complete remission and recurrence. In total, 170 women treated at Karolinska University Hospital in Sweden and Aarhus University Hospital in Denmark between 1994 and 2018 were included, of whom 107 were given im and 63 oral MTX. MTX-R developed in 35% and 54% in the im and oral groups, respectively (p = 0.01). There was no difference in days to hCG normalization (42 vs. 41 days, p = 0.50) for MTX-sensitive women. Toxicity-induced treatment switch was only seen in the im group. Complete remission was obtained in 99.1% and 100% (p = 0.44), and recurrence rate within one year was 2.8% and 1.6% (p = 0.29). The form of administration of MTX had a significant impact on development of MTX-R and treatment-associated toxicity, but does not affect rates of complete remission, recurrence or survival.
摘要：
甲氨蝶呤（MTX）经常用作低风险妊娠滋养细胞肿瘤（GTN）的一线治疗。静脉和肌内（IM）给药途径是最常见的方法，虽然一些斯堪的纳维亚中心使用口服给药。这项研究的主要目的是评估低风险GTN中给药形式（口服/口服）对甲氨蝶呤（MTX-R）治疗耐药性的影响。次要目标是hCG正常化的时间，毒性诱导的治疗转换率，完全缓解和复发率。总的来说,包括1994年至2018年间在瑞典卡罗林斯卡大学医院和丹麦奥胡斯大学医院接受治疗的170名妇女，其中107例给予IM和63例口服MTX。在IM和口服组中，MTX-R分别为35%和54%，分别(p=0.01)。hCG正常化的天数没有差异（42vs.41天,对于MTX敏感的女性，p=0.50）。仅在im组中观察到毒性诱导的治疗转换。完全缓解率分别为99.1%和100%(p=0.44),一年内复发率分别为2.8%和1.6%(p=0.29)。MTX的给药形式对MTX-R的发展和治疗相关的毒性有重大影响，但不影响完全缓解率，复发或存活。
