Abstract：
BACKGROUND: Gestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy.
OBJECTIVE: To report the experience of a statewide registry in the treatment of low-risk gestational trophoblastic neoplasia (GTN) over a 20-year period.
METHODS: A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low-risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed.
RESULTS: The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0-29 days). Seventy-seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi-agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5-6 (odds ratio (OR) 6.56, 95% CI 1.73-24.27, P = 0.005) and those with pre-treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73-24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry.
CONCLUSIONS: Methotrexate is a highly effective treatment for low-risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5-6 requires further investigation.
OBJECTIVE: To report the experience of a statewide registry in the treatment of low-risk gestational trophoblastic neoplasia (GTN) over a 20-year period.
METHODS: A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low-risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed.
RESULTS: The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0-29 days). Seventy-seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi-agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5-6 (odds ratio (OR) 6.56, 95% CI 1.73-24.27, P = 0.005) and those with pre-treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73-24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry.
CONCLUSIONS: Methotrexate is a highly effective treatment for low-risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5-6 requires further investigation.
摘要：
背景：妊娠滋养细胞疾病（GTD）是一种罕见但高度可治疗的疾病。指导治疗的当地证据有限。
目的：报告全州注册在20年内治疗低风险妊娠滋养细胞肿瘤（GTN）的经验。
方法：对前瞻性维护的GTD注册数据库进行回顾性审查。有144名患者被确定为低风险GTN，其中115项进行了分析。患者人口统计学，治疗细节和结果，包括抵抗力的发展，对毒性或复发进行了审查。
结果：GTD的发生率为2.6/1000活产。有100%的生存。从诊断到开始治疗的平均时间为1.9天(范围0-29天)。用甲氨蝶呤治疗的患者中有77%达到完全缓解。13例患者（11.3%）需要多药化疗，用于治疗耐药或复发性疾病。世界卫生组织（WHO）风险评分为5-6（比值比（OR）6.56，95％CI1.73-24.27，P=0.005）和治疗前人类绒毛膜促性腺激素>10000（OR4.0095％CI1.73-24.27P=0.007）的患者的治疗耐药率较高。开始治疗后，四名患者（3.5％）被诊断为绒毛膜癌。9名患者（7.8％）成功接受了GTN手术治疗，单独和联合化疗。复发率为4.3%；所有患者均通过化疗和手术联合治疗成功。93.9%的患者通过注册完成了随访.
结论：甲氨蝶呤是低风险GTN的高效治疗方法，尤其是WHO风险评分≤4分。风险评分为5-6的患者的最佳治疗方法需要进一步调查。
目的：报告全州注册在20年内治疗低风险妊娠滋养细胞肿瘤（GTN）的经验。
方法：对前瞻性维护的GTD注册数据库进行回顾性审查。有144名患者被确定为低风险GTN，其中115项进行了分析。患者人口统计学，治疗细节和结果，包括抵抗力的发展，对毒性或复发进行了审查。
结果：GTD的发生率为2.6/1000活产。有100%的生存。从诊断到开始治疗的平均时间为1.9天(范围0-29天)。用甲氨蝶呤治疗的患者中有77%达到完全缓解。13例患者（11.3%）需要多药化疗，用于治疗耐药或复发性疾病。世界卫生组织（WHO）风险评分为5-6（比值比（OR）6.56，95％CI1.73-24.27，P=0.005）和治疗前人类绒毛膜促性腺激素>10000（OR4.0095％CI1.73-24.27P=0.007）的患者的治疗耐药率较高。开始治疗后，四名患者（3.5％）被诊断为绒毛膜癌。9名患者（7.8％）成功接受了GTN手术治疗，单独和联合化疗。复发率为4.3%；所有患者均通过化疗和手术联合治疗成功。93.9%的患者通过注册完成了随访.
结论：甲氨蝶呤是低风险GTN的高效治疗方法，尤其是WHO风险评分≤4分。风险评分为5-6的患者的最佳治疗方法需要进一步调查。
