Clinical Data Analysis Of 47 Cases With High-risk Gestational Trophoblastic Neoplasia

Objective: Gestational trophoblastic neoplasia is a kind of maligant tumor which is occuring in young women of child-bearing age, can be cured.Chemotherapy is the main treatment method of gestational trophoblastic neoplasia.With the principle of individualization and hierarchy, the clinicians formulate different chemotherapy regimens in different patients.The chemotherapy of high- risk GTN should apply combined chemotherapy and prefers EMA/CO in our hospital.This article is written to discuss the clinical effects and toxic side effects that induced by two differents kinds of chemotherapy on the treatment of high- risk GTN so as to accumulate the experience for clinical treatment.Methods: Date on a total 47 cases with high-risk GTN in department of gynaecology of the Fourth Hospital affiliated Hebei Medical University from December 2004 to December 2013 were analyzed retrospectively and divided into the study group with 24 and the control group with 23.The patients in the study group were given the EMA/CO,while the patients in the control group were treated by EMA-CO+EMA who begin chemotherapy with an average of one or two courses of chemotherapy regimens of EMA/CO and whose subsequent chemotherapy regimens are EMA instead because of serious toxic side effects of chemotherapy(Ⅰlevel and above) and logarithmic fell of HCG. According to standards of GTN after treatment to evaluate respectively the efficacy of the the two groups at the end of the sixth chemotherapy course and according to standards of WHO clinical evaluation of anticancer drugs to evaluate respectively the toxic side effects of the the two groups at the beginning of the fourth,the fifth and the sixth chemotherapy course,including leucopenia, ALT, lipsotrichia, nausea and vomiting, diarrhea or abdominal distension.Then the rate of total efficacy and the incidence of adverse reactions of patients were observed and compared between the two groups. Data were analyzed using SPSS.Data constitute the differences were compared using t-test,χ2 test,rank sum test,P<0.05 was statistically significant.Results:1 There was no statistic significance between the two groups in Average age, histological type, disease stage, age structure, the types of the previous pregnancy, time of apart from the previous pregnancy, HCG value before treatment, maximum tumor size, the number of metastatic lesions(P>0.05).2 At the end of the sixth chemotherapy course,there was no statistic significance between the two groups of the total effective rate and the effective rate in IM or CC,also no statistic significance between IM and CC in the study group(P > 0.05).There was no statistic significance of the effective rate betweenⅠstage and Ⅲ stage GTN in the study group(P>0.05).There was no statistic significance of the effective rate between the patients applying one course EMA/CO and the patients applying two courses EMA/CO in study group.(P>0.05).There was no statistic significance between the two groups of the number of chemotherapy courses of HCG dropped to normal.The study group is shorter than the control group in the total treatment time,the difference is statistically significant(P<0.05).3 At the beginning of the fourth,the fifth and the sixth chemotherapy course,there were statistically significant differences about the leukopenia reduction and lipsotrichia between the two groups(P<0.05).There was no significant difference between the two groups at the beginning of the fourth chemotherapy course about ALT level, nausea and vomiting, diarrhea or abdominal distension(P>0.05),but there were statistically significant differences at the beginning of the fifth and the sixth chemotherapy course about three kind of toxic side effects mentioned above(P<0.05).Conclusions: The rate of total efficacy in the control group is similar to the the study group which was with no significant difference while the toxic side effects are mild,and the regimen is easy to be accepted by the patients,which has clinical application and promotion value.It is indicated that the application of EMA/CO + EMA on the treatment of malignant trophoblastic tumor should be well promoted to the clinical field.