The Analysis Of High-Risk Factors Of Chemorefractory In Gestational Trophoblastic Neoplasia

Objective: To explore high-risk factors of chemofractory in gestationaltrophoblastic neoplasia(GTN).Methods:Clinical data of128hospitalized patients with GTN during2004to2011in the First Affiliated Hospital of Guangxi Medical University wereretrospectively reviewed. Data were compared between18patients with chemo-fractory and100patients achieving complete remission by initial chemotherapy.Logistic regression was performed to analyze the high-risk factors of chemo-refractory.Results:Of128patients,89.8%had complete remission with first-line orsalvage chemotherapy. The incidence of developed chemofractory was14.1%(18/128). Three patients died of GTN and their Figo prognostic score were allmore than12. Of the3women,2died of brain metastases and one died afterhemoptysis because of poor financial condition. Fifteen out of18(83.3%)chemorefractory patients achieved complete response with salvage chemo-therapy.The result of single-factor analysis shows that the factors contributing tochemofractory were antecedent pregnancy, HCG level before initial chemo- therapy, metastases, site of mass, choriocarcinoma, stage and FIGO prognosticscore. In the multiple-factor logistic regression analysis, tumor with≥5cm indiameter, stage III-IV and previous non-molar pregnancy are significantprognostic factors for chemofractory.Conclusion: GTN is highly curable with chemotherapy. Chemotherapyregimens should be individualized. GTN should be diagnosed and treated early.Chemorefractory GTN should be treated with salvage chemotherapy, adjuvantsurgery and radiotherapy when indicated. Surgical procedures play an importantrole in the therapy of chemorefractory GTN.