An Clinical Analysis Of Low Risk Gestational Trophoblastic Neoplasia In 91 Patients

Objective:To investigate the efficacy and safety of initial chemotherapy in low-risk gestational trophoblastic neoplasia and evalute the risk factors of LRGTN single drug resistance;To discuss the clinical factors affecting the next chemotherapy options after the first-line single drug resistance.Method:Retrospective analysis of the clinical data of 91 patients diagnosed as LRGTN and received standardized treatment in Tianjin Center Hospital of Gynecology and Obstetrics from 2012.1.1 to 2017.11.1.Calculate the remission rate and the incidence of side effects of each chemotherapy regimen.Adopting SPSS 20.0 and using X~2test,Fisher’s exact test to evalute the relationship between clinical factors and initial treatment options for LRGTN patients、initial single-agent chemotherapy resistance、second choice of chemotherapy in initial drug resistance.Result:1.Among 78 receiving monotherapy LRGTN patients,11 bi-weekly pulsed ActD,15five-day intravenous Act-D,52 five-day intravenous MTX,the drug resistance rates were 36.36%(4/11),40.00%(6/15),and 42.31%(22/52),respectively.There was no significant difference in the remission rate between those chemotherapy.There were13 cases receiving multidrug therapy and getting remission without resistance.Among the 91 cases,8 cases received adjuvant surgery.2.In 78 monotherapy cases,the incidence of myelosuppression were 45.45%,80.00%,and 78.85%respectively and the probability of III-IV myelosuppression were 9.09%、20%、26.92%,respectively in bi-weekly pulsed ActD、five-day intravenous Act-D、five-day intravenous MTX.There was no significant difference in the incidence of the three groups(P>0.05).Only 2 cases of myelosuppression with IV degree appeared in five-day intravenous MTX treatment;The incidence of hepatic impairent inbi-weekly pulsed ActD、five-day intravenous Act-D、five-day intravenous MTX was 45.45%,46.67%,and 50%.There was no statistically significant difference between the three groups.7 severe liver damage occurred in MTX therapy while no case of III-IV liver damage in both Act-D therapies.The incidence of gastrointestinal adverse reactions,hair loss rate were 100%,with I-II degrees.3.There was a statistically significant difference in age,FIGO score,pretreatment serumβ-HCG level,and whether the adjuvant surgical treatment was used in the initial treatment of LRGTN patients,the initial remission rate in the single-agent chemotherapy group and multi-agent chemotherapy group(P<0.05).There was no significant difference in onset distance from the last gestation interval,FIGO stage,the number and size of uterine lesions,the number and size of lung metastases on the lung CT scan(P>0.05).4.The levels ofβ-HCG and FIGO scores in the single-agent chemotherapy-remission group and resistant group were statistically different(P<0.05).In other words,the pre-treatment bloodβ-HCG levels≥1×10~4mIU/ml、FIGO scores of 4 to 6 were more resistant to initial treatment with single-agent chemotherapy.Though there was no significant difference in age、interval from last gestation、FIGO stage、number of uterine lesions、the number and size of lung metastases shown by CT(P>0.05).5.After the initial monotherapy drug resistance,another monotherapy or a direct multi-drug combination chemotherapy group were selected for next treatment.The levels of bloodβ-HCG were different when the two drugs were resistant and the difference was statistically significant(P<0.05).Blood HCG levels often exceeded 1×10~4mIU/ml in patients choosing combination chemotherapy;There was no statistically significant difference in remission rate,age,distance to last gestation interval,FIGO stage,FIGO score,size and number of uterine lesions.(P>0.05).6.4 cases of monotherapy drug resistance were changed to multidrug combination chemotherapy.The degree of side effects of chemotherapy was more severe than before:Gastrointestinal tract reaction was upgraded from degree I to grade III,and myelosuppression was upgraded from grade I to grade III,1 achieved Grade IV.Excluding these 4 cases,the incidence of myelosuppression and liver damage after chemotherapy in the multidrug combination treatment group was slightly higher than that of the single drug group(76.92%VS 72.97%,76.92%VS 50%),but the difference was only statistically significant in liver damage(P<0.05);The multi-drug group was more prone to severe side effects of chemotherapy than the single drug group,in which the degree of myelosuppression at III-IV was 46.15%and 24.32%,and the degree of liver damage was 15.38%and 9.46%,respectively,but the difference was not statistically significant significance(P>0.05).The incidence of adverse reactions and alopecia in the gastrointestinal tract was 100%in both groups,and III-IV gastrointestinal adverse reactions(30.77%VS 0%)and hair loss(7.14%VS 0%)were more likely to occur in the multidrug group,but the difference was not statistically significant(P>0.05)Conclusion:LRGTN is the preferred single-agent chemotherapy.The following three single-agent chemotherapy regimens:bi-weekly pulsed ActD、five-day intravenous Act-D、five-day intravenous MTX are all suitable,considering side effects of chemotherapy,more inclined to choose Act-D single drug program.The pre-treatment bloodβ-HCG levels≥1×10~4mIU/ml、FIGO scores 4-6 are high risk factors of LRTTN initial single-agent chemotherapy resistance.It is more appropriate to directly apply multi-drug combination chemotherapy to such LRGTN patients.3.For LRGTN initial treatment of single-drug resistance,with resistance levels of bloodβ-HCG greater than 1×10~4mIU/ml,it is recomended to switch to multi-drug combination chemotherapy to shorten the treatment time.4.The rate of side effects of chemotherapy for multi-drug combination chemotherapy regimens is higher than for monotherapy,and is often heavier once it occurs.