Clinical Analysis Of43Cases With High-risk Gestational Trophoblastic Neoplasia

Background:Gestational trophoblastic neoplasia is a rare gynecological tumor, but can be curable by chemotherapy. Patients with WHO scores equal to or greater than7are considered high risk and treated with multi-agent chemotherapy. Certain risk factors, such as stage IV disease and a WHO score of greater than or equal to12have been identified as predisposing patients to chemotherapy resistance, ultimately affect the prognosis.Objective:By retrospective analysis of clinical cases of high-risk gestational trophoblastic neoplasia, explore the diagnosis, treatment, prognosis and related factorsMaterials and methods:Date on a total390cases with GTN in Women Hospital affiliated Zhejiang University from August2007to August2012were reviewed,43patients with high-risk GTN were analyzed retrospectively.Results:Among43patients of high-risk GTN, FIGO stage was Ⅰ in12patients (28%), Ⅱ in2cases (5%), Ⅲ in22cases (51%), and Ⅳ in7cases (16%). The WHO prognostic risk factor scores ranged from7to12in38cases (88%), the prognostic score is greater than or equal to12in5patients (12%). All patients were initially treated with EMA-CO chemotherapy, drug-resistant patients were switched to EP-EMA chemotherapy. Forty-three patients received a total of317courses of combination chemotherapy. The average number of courses for each patient was7.37. The complete clinical cure rates were95%(41/43) in all patients,67%(29/43) in patients receiving chemotherapy only, and92%(12/13) in patients receiving chemotherapy combined with surgery, not cured in2cases, no deaths. During the therapy,13patients underwent planned surgery. Analysis the correlation of high-risk factors and prognosis, found the complete clinical cure rate is significantly associated with the FIGO prognostic score(P=0.011) and drug resistance(P=0.017). All patients underwent regular follow-up, range6months to4years and8months,17patients were lost from follow-up, and no patient had recurrence.Conclusions:1. EMA-CO is the first-line regimen used to treat high-risk GTN.2. Patients with high-risk GTN should be treated initially with multi-agent chemotherapy with or without adjuvant radiation therapy and/or surgery, the treatment effect is well.3. For high prognostic score in patients with widespread metastatic, especially in high-risk patients with drug-resistant, the cure rate is low. Multi-drug chemotherapy and combined adjuvant selective surgical intervention should be use to improve the survival rate.