Clinical Analysis Of 65 Cases Of Gestational Trophoblastic Neoplasia

Objective:Through retrospective analysis of the clinical cases of gestational trophoblastic neoplasia in the the department of gynecology of the first affiliated hospital of Soochow University,to summarize the experience and explore the best treatment of the disease.As far as possible to reduce side effects and drug resistance rate, thereby improve the curative effect.Methods:1. A retrospective analysis of 65 cases who were diagnosed of GTN from October2007 to February 2015 in the the department of gynecology of the first affiliated hospital of Soochow University was made.All patients were grouped according to FIGO staging and improved the modified WHO scoring system.2. Mainly to compare the MTX-CF regimen of the efficiency、drug resistance rate and the courses return to normal with the 5-FU+KSM regimen by statistical analysis,especially for the low-risk patients with a prognostic score of 5-6 or FIGO stage III.3. Analysis the drug resistance related factors by chi-square test and Logistic regression analysis.4. To compare all kinds of toxicity and side effects of different regimens.5. To compare the surgery or other adjunctive treatment group of the efficiency and the courses return to normal with the group treated with chemotherapy alone,6. Investigate the pregnancy outcomes by follow-up.Results:1. The patients who recieve 5-FU+KSM regimen showed a better complete response than MTX-CF regimen(overall complete remission rate 85.3% vs 45.8%, p=0.01),Also the low-risk group showed the same outcome.But we can’t make the conclusion in high-riskgroup because of the small sample.2. The low-risk patients with a prognostic score of 5-6 or FIGO stage III achieve better complete response by 5-FU+KSM regimen than MTX-CF regimen.3. The result of single-factor analysis shows that the factors contributing to chemofractory were age(≥40 years old), h CG level before initial chemotherapy(≥104U/L)and the prognostic score(≥5).In the multiple-factor logistic regression analysis, age ≥40years old is significant prognostic factors for chemofractory.4. The main reported side effects include nausea and vomiting, bone marrow suppression, alopecia, oral ulcer, liver damage, etc. The “MTX-CF” regimen reported less side effects than “5-FU+KSM” regimen(33.3% Vs 92.9%, p=0.00)5. Selective arterial embolization contributes to less causes than chemotherapy alone(p=0.014), but we didn’t find surgery helpful to shorten the chemotherapy causes(p=0.262).6. As for the pregnancy outcomes of GTN patiens, the overall fertility rate was85.7%, and the live term birth rate was 76.2%.Conclusion:1. The 5-FU+KSM/Act-D regimen was widely used in our hospital, whose significant advance was confirmed,but the side effects cannot be neglected. We advise that low-risk patients at stage I-II with prognostic score 0-4 can be treated with single agent.2. While to low-risk patients at stage III or prognostic score 5-6,single agent is unlikely to be effective and therefore combined chemotherapy is recommended. We shoud especially pay attention to the patients with chemofractory factors,3. Don’t ignore the important role of surgery or or other adjunctive treatment.4. Generally, the patients’ prognosis and pregnancy outcome are satisfied and achieve the overall cure rate of 98.4%.