| Objective:The gestational trophoblastic neoplasia(GTN)patients with the International Federation of Gynecology and Obstetrics(FIGO)score>12 are defined as ultra high-risk GTN,who have a poor prognosis.This study aims to investigate the clinical characteristics,the treatment efficiency,and the prognosis of ultra high-risk GTN patients,which can provide more valuable information for diagnosis and treatment of ultra high-risk GTN.Methods:Between January 2002 and December 2015,medical record data of 143 GTN patients with FIGO score?12 at Peking Union Medical College Hospital(PUMCH)were reviewed.Ratios were compared using chi-square test.Univariate analysis and multivariate analysis were used to analyze the prognosis-related risk factors of ultra high-risk GTN patients.Results:Among the 143 ultra high-risk GTN patients,94(65.7%)patients had achieved complete remission and 15.9%(15/94)patients relapsed after complete remission.There was a statistically significant difference of complete remission rate between patients with previous chemotherapy failure and patients without previous chemotherapy(56.1%vs 86.7%,P=0.001).The 5-year overall survival(OS)rate of the entire cohort approached 67.9%.The results of the multivariate analysis revealed that non-molar antecedent pregnancy[Relative risk(RR)4.689,95%CI 1.448-15.189,P=0.010].brain metastases(RR 2.280,95%CI 1.248-4.163,P=0.007),previous failed multiagent chemotherapy(RR 5.345,95%CI 2.222-12.857,P=0.000)and surgery(RR 0.336,95%CI 0.177-0.641,P=0.001)all had influence on prognosis of ultra high-risk GTN patients.Conclusions:GTN patients with FIGO score>12 have a poor prognosis.More emphasis should be placed on non-molar antecedent pregnancy,brain metastases,and previous multiagent chemotherapy failure.Moreover,salvage surgery may improve the prognosis of ultra high-risk GTN.Floxuridine-based multiagent chemotherapy(Floxuridine?Actinomycin?Etoposide?Vincristine)is effective with manageable toxicity for ultra high-risk GTN patients. |
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