| Objective:To compare of the EP regimen for treatment of gestational trophoblastic neoplasia with5-FU+KSM regimen and analysis its drug resistance related factors.Methods:A retrospective study of134cases of patients with high-risk gestational trophoblastic neoplasia over a17-year period at the Qilu Hospital of Shandong University, a tertiary referral center, between January2003and January2013. Statistically analyzing the common features, past marital and fertile history, laboratory examinations, diagnosis, prognostic scores, treatment and drug side effects of the two different treatment groups and figure out the related factors that affected the drug resistance of high-risk gestational trophoblastic neoplasia patients.Results:The total number of EP regimen group is96, of which the number of complete remission patients is74and makes the complete remission rate77.1%. The total number of5-FU+KSM regimen group is38, of which the number of complete remission patients is24and makes the complete remission rate63.2%. Results were performed using χ2test and have no statistically significance(P=0.359). The total number of EP regimen subgroup whose prognostic score is less than13is86, of which the number of complete remission patients is72and makes the complete remission rate83.7%. The total number of EP regimen subgroup whose prognostic score is more than12is10, of which the number of complete remission patients is2and makes the complete remission rate20.0%. Results were performed using χ2test and have statistically significance(P=0.007). The EP group has470courses of chemotherapy in all, the most prevalent side effects among those were nausea/vomiting(88.1%), leucopenia(71.1%) and alopecia(46.0%). There were24courses of chemotherapy delayed due to the marrow suppression. The5-FU+KSM group has188courses of chemotherapy in all, the most prevalent side effects among those were nausea/vomiting(93.6%), leucopenia(75.5%), oral ulceration(69.1%), diarrhea(60.6%) and alopecia(45.7%). There were36courses of chemotherapy delayed due to the marrow suppression.The total number of antecedent hydatidiform mole pregnancy is62(46.3%), of which the number of complete remission patients is52and makes the complete remission rate83.9%. The total number of antecedent abortion pregnancy is34(25.4%), with the30complete remission ones and the complete remission rate reached88.2%. The others were antecedent full-term pregnancy with the number of38(28.3%), and16complete remisson ones and the rate reached42.1%. The antecedent full-term pregnancy patients’complete remission rate is different form the others and χ2test both show statistically significance(P<0.05). Another risk factor related with prognosis is the interval from index pregnancy. We designed four groups as<4months,between4and7months, between7and13months and≥13months. The complete remission rate of these four groups showed that only≥13months group has statistically significance(P<0.05). The other new risk factor we figured out in this study is the serum hCG level descending trend after first course chemotherapy. The patients were separated into two groups according to whether her serum hCG had lower than one-tenth of pretreatment hCG. The positive group had80ones, with the66complete remission ones and the complete remission rate reached82.5%. The negative group had18patients and the number of complete remisson ones were6, with the rate33.3%. The two results have statistically significance(P<0.004). Conclusions:The EP regimen for treatment of gestational trophoblastic neoplasia compare with5-FU+KSM regimen has no statistically significance in the efficacy. But the acute side effects of5-FU+KSM regimen are more serious and intolerant. The study also shows that antecedent full-term pregnancy, interval from index pregnancy≥13months, prognostic score more than12and serum hCG more than one-tenth of pretreatment hCG after first course chemotherapy can be the risk factors related with drug resistance. |
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