对1971年至1995年采用不同化疗方案治疗的高危妊娠滋养细胞肿瘤(GTT)进行了回顾性和比较研究,以寻找最有效的化疗方案和独立危险因素。在KRI-TRD(韩国妊娠滋养细胞疾病研究所)注册的2,418名GTD患者中,接受化疗的802名GTT病例中有三百七名患者在WHO分类中得分超过8分,被归类为高风险组,韩国天主教大学医学院。将227例高危GTT患者的多药联合化疗的研究组分为49例MTX+亚叶酸和Act-D联合化疗,40例MAC方案,42例CHAMOCA方案,96例EMA/CO。根据hCG滴度下降的初始肿瘤反应被发现在良好的反应(对数下降)69.8%,EMA/CO方案组。另一方面,只有24.5%的MTX+ACT-D显示良好的反应,MAC方案的32.5%,52.4%,分别为CHAMOCA方案。EMA/CO方案缓解率为90.6%(87/96),化疗疗程为8.5±2.2。然而,MTX+Act-D其他方案的缓解率,MAC,查莫卡为63.3%,(31/49)分别为67.5%(27/40)和76.2%(32/45),化疗疗程分别为10.0±4.0、10.7±4.3、9.1±3.9,直至缓解。因此,发现EMA/CO方案组有低药物毒性,早期缓解和低失败率。在165例接受EMA/CO方案的高危妊娠滋养细胞肿瘤患者的独立危险因素研究中,使用多变量分析显示肿瘤年龄的预后因素的逐步Coxs比例风险回归,转移器官的数量,转移部位和先前化疗不足。根据拟合逻辑回归模型的性能,死亡率和生存率的预测率为80.5%。
结论:对高危GTT最有效的化疗方案是EMA/CO方案。以下因素显示预后不良:1)肿瘤年龄超过12个月,2)2个以上器官有转移灶,3)以前的治疗不充分,包括计划外的手术和以前的化疗不充分。
A retrospective and comparative study of high-risk gestational trophoblastic tumor (GTT) treated with different chemoregimen from 1971 to 1995 was performed and to find most effective chemotherapy regimen and independent risk factors. Three hundred seven patients in scoring over 8 points in WHO classification were categorized into high-risk group among 802 GTT cases received chemotherapy in the 2,418 GTD patients registered at KRI-TRD (Korean Research Institute for Gestational Trophoblastic Disease), Catholic University Medical College in Korea. Study groups of multiagent combination chemotherapy in 227 patients of the high-risk GTT were divided such as 49 cases of combination chemotherapy with MTX + folinic acid and Act-D, 40 cases of MAC regimen, 42 cases of CHAMOCA regimen, and 96 cases of EMA/CO. Initial tumor response according to hCG titer decrease was found in good response (log fall) 69.8%, of EMA /CO regimen group. On the other hand, good response was shown in only 24.5% of MTX + ACT-D, 32.5% of MAC regimen, and 52.4%, of CHAMOCA regimen respectively. Remission rate of EMA/CO regimen was 90.6% (87/96) and courses of chemotherapy until remission was 8.5 ± 2.2. However, remission rate of other regimens of MTX + Act-D, MAC, and CHAMOCA were 63.3%, (31/49) 67.5% (27/40) and 76.2% (32/45) respectively, with 10.0 ± 4.0, 10.7 ± 4.3, 9.1 ± 3.9 chemotherapy courses respectively until remission. Therefore, EMA/CO regimen groups were found to have low drug toxicity, early remission and a low failure rate. In the study of independent risk factors in the 165 cases of high-risk gestational trophoblastic tumor patients received EMA/CO regimen, stepwise Coxs proportional hazard\'s regression of prognostic factors using multivariate analysis revealed tumor age, number of metastatic organs, metastatic site and inadequate previous chemotherapy. According to the performance of fitted logistic regression model, the prediction rate of death and survival was 80.5%.
CONCLUSIONS: The most effective chemotherapy to high-risk GTT was EMA/CO regimen than other regimens. The following factors showed poor prognosis; 1) Tumor age is over 12 month, 2) more than 2 organs had metastatic lesion, 3) inadequate previous therapy that includes unplanned operation and inadequate previous chemotherapy.