| Objective: To evaluate the curative effect and prognosis of different treatment methods of gestational trophoblastic disease with drug resistance or relapse by retrospectively analyze the clinical data,so as to provide valuable information for the treatment of drug-resistant or recurrent gestational trophoblastic disease.Methods: Retrospective analysis of 98 cases of relapsed or drug-resistant gestational trophoblastic tumor treated in Zhejiang University Hospital of Obstetrics and Gynecology from January 1,2014 to March 31,2017,The clinical data like age,previous pregnancy history,metastatic site,diagnosis,?-HCG value,FIGO score and staging,chemotherapy regimen,surgical type and follow-up were collected.According to whether they were relapsed or drug-resistant gestational trophoblastic tumors and their FIGO prognosis scores and stages,there were three groups: low-risk drug-resistant group,high-risk drug-resistant group and relapsed group.The clinical characteristics,chemotherapy,adjuvant treatment and prognosis of different groups were compared and analyzed.Results: Of 98 patients,83 were in low-risk drug-resistant group,10 in high-risk drug-resistant group and 15 in relapsed group,The median age of low-risk drug-resistant,high-risk drug-resistant and relapsed groups was 29(14-54),30.5(28-45)and 30(23-48),respectively,The median prognostic scores were 3(1-6),8.5(7-11),and 7(1-12),respectively.The median time of the previous pregnancy was 1.5(0.7-36),12(4-48),and 9(1-30)months,respectively.The median values of ?-HCG before treatments were 5566(130-514972)IU/L,22282(1527-204260)IU/L and 3407(443-36710)IU/L,respectively.The median time from the end of chemotherapy to drug resistance or relapse was 6(2-44)weeks,6(3-20)weeks and 24(4-120)weeks,respectively.There were 49 cases of pulmonary metastasis in low-risk drug-resistant group,7 cases of pulmonary metastasis in high-risk drug-resistant group,8 cases of pulmonary metastasis in relapsed group,and 2 cases of other sites metastasis(brain and kidney).There was no statistically significant difference in age between low-risk,high-risk and relapsed groups(P>0.05).The other related indexes were statistically significant.In the low-risk drug-resistant group,71 patients with MTX were treated with Act-D alone,and 69 patients were treated with Act-D,The second drug resistance occurred in 19 patients.Chemotherapy regimens such as EMA-CO,5FU and EMA were used in the second treatment.F4 patients received Act-D single-drug chemotherapy and resection of metastatic lesions.Two of the patients underwent surgery after the second chemotherapeutic resistance The overall serum remission rate was 98.63%.EMA-C0 Combined Chemotherapy was carried out in 1 case of high-risk drug-resistant group,4 cases were treated with EMA-EP Combined Chemotherapy,and 5 cases were treated with combined chemotherapy plus resection of metastatic lesions.The overall remission rate was 80%.There were 11 cases in relapsed group treated with chemotherapy only,3 cases of chemotherapy combined with surgery,1 case of chemotherapy combined with surgery and radiotherapy,and the overall serologic remission rate was 86.67%.Conclusion: The overall cure rate of GTN is high after drug resistance or relapse.The cure rate of GTN is related to FIGO score,whether there is metastasis and standard treatment.If low-risk GTN is resistant to single-drug chemotherapy,serologic remission can still be achieved by exceptional single-drug chemotherapy,even if the drug resistance is repeated and cured by combination chemotherapy is still possible.High risk of recurrent gestational trophoblastic tumor should be treated with combination chemotherapy,active adjuvant surgery and even radiotherapy. |
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