长春新碱放线菌D依托泊苷氟脲苷治疗高危型妊娠滋养细胞肿瘤的疗效观察

目的探讨长春新碱+放线菌D+依托泊苷+氟脲苷(FAEV)方案治疗高危型妊娠滋养细胞肿瘤(GTN)的临床疗效。方法选取2011年1月至2012年12月间接受初次化疗的38例高危型GTN患者,按照随机数字表法分为实验组和对照组,每组19例。实验组患者接受FAEV方案化疗,对照组患者接受氟尿嘧啶+更生霉素(5-Fu+KSM)方案化疗,观察比较两组患者的临床疗效、疗程及不良反应。结果实验组患者血清学意义上的完全缓解(s CR)率、耐药(NR)和复发(REC)发生率分别为78.9%、21.1%和0.0%,对照组则分别为57.9%、26.3%和5.3%,差异均有统计学意义(P<0.05)。实验组患者中,3例NR改行放线菌素D+甲氨蝶呤+环磷酰胺+长春新碱+VP16(EMA-CO)方案化疗后获得s CR。对照组患者中,6例NR患者改行EMA-CO方案化疗后获得s CR。对照组患者中,2例REC患者先行手术切除治疗后,再行EMA-CO方案化疗后获得s CR。实验组患者绒毛膜促性腺激素β-亚基(β-h CG)下降至≤2 U/L疗程、巩固化疗疗程数及总疗程数与对照组间差异无统计学意义(P>0.05)。实验组的口腔溃疡、腹泻发生率分别为5.3%和10.5%,对照组则分别为84.2%和68.4%,差异有统计学意义(P<0.05)。结论 FAEV化疗方案治疗高危型CTN疗效显著,不良反应发生率低。     

放线菌素D、甲氨蝶呤或5-氟尿嘧啶单药初次治疗低危型妊娠滋养细胞肿瘤效果及安全性

目的:评估放线菌素D（Act-D）、甲氨蝶呤（MTX）或5-氟尿嘧啶（5-Fu）单药初次化疗低危型妊娠滋养细胞肿瘤（GTN）的效果及安全性。方法:回顾性分析2012年1月至2020年1月山西省大同市第一人民医院109例接受单药初次化疗的低危型GTN患者资料,其中Act-D组38例,MTX组37例,5-Fu组34例。通过...     

化疗联合手术治疗耐药性妊娠滋养细胞肿瘤的临床分析

目的 探究化疗联合手术治疗耐药性妊娠滋养细胞肿瘤(Gestational trophoblastic neoplasia,GTN)患者的临床效果。方法 选择耐药的高危型GTN患者76例,随机分为对照组和研究组,各38例;对照组使用足叶乙甙+甲氨蝶呤+放线菌素D/足叶乙甙,顺铂(etoposide,methotrexate,and actinomycin-D/etoposide and cisplatin,EMA/EP)方案化疗,研究组使用化疗联合手术治疗的方法治疗;比较两组的治疗效果、预后、外周血林白细胞亚群以及不良反应发生情况。结果 治疗6个月后研究组的客观缓解率(Objective response rate,ORR)高于对照组,差异具有统计学意义(P=0.024);研究组的耐药率和复发率低于对照组(P＜0.05);治疗前两组血清人绒毛膜促性腺激素(Human chorionic gonadotropin,HCG)差异无统计学意义,治疗后两组HCG水平均降低(P＜0.001),治疗后6个月、12个月和末次随访研究组的血清HCG水平低于对照组(P＜0.001);治疗前两组外周血T细胞亚群水平差异无统计学意义,而治疗6个月后均有不同程度的改善;研究组的CD3⁺、CD4⁺和CD4⁺/CD8⁺T细胞高于对照组(P＜0.001);研究组的中性粒细胞减少、血红蛋白降低、恶心呕吐、脱发的发生率则低于对照组(P＜0.05)。结论 对于一线耐药的高危GTN患者,化疗联合手术治疗具有更好的治疗效果,并可有效改善机体免疫水平,降低不良反应的发生。     

恶性滋养细胞肿瘤53例临床分析

目的 探讨恶性滋养细胞肿瘤的治疗及化疗方案的选择。方法 回顾性分析1993年2月至2001年10月收治的53例恶性滋养细胞肿瘤,Ⅰ期30例,Ⅱ期5例,Ⅲ期15例,Ⅳ期3例。实施5-FU+KSM,EMA-CO方案,DDP+MTX+TX方案化疗,23例接受子宫切除术。结果 全组CR79.25％、PR16.98％;Ⅲ、Ⅳ度白细胞和血小板减少的发生率EMA-CO方案显著高于其他方案。结论恰当的综合治疗有利于改善恶性滋养细胞肿瘤的预后,要重视EAA-CO方案的化疗毒副反应,不宜以EMA-CO方案取代传统的5-FU+KSM方案。     

高预后评分妊娠滋养细胞肿瘤患者化疗疗效及耐药因素分析

目的虽然低危妊娠滋养细胞肿瘤(low risk gestational trophoblastic neplasms,LRGTN)采用单药化疗方案能获得较高的治愈率,但仍有部分预后评分为5~6分的LRGTN患者发生耐药。本研究探讨联合化疗方案治疗高预后评分LRGTN患者的化疗疗效、耐药因素以及最佳联合方案。方法回顾性分析广西医科大学附属肿瘤医院妇瘤科1998-01-01-2016-12-31收治的84例病历信息完整使用联合化疗方案的低危组妊娠滋养细胞肿瘤病例,按2000年改良预后评分分为5~6和0~4分组,对年龄、是否有肺转移、分期及预后评分等可能影响低危组GTN患者疗效及治愈时间的临床因素进行单因素分析,并分别探讨不同联合化疗的疗效。结果5~6分组LRGTN患者诊断为绒癌(χ^2=4.356,P=0.037)、分期晚(χ^2=9.230,P=0.002)以及发生转移(χ^2=11.850,P=0.001)的比例均高于0~4分组,差异有统计学意义。5~6分组LRGTN患者的完全缓解率、耐药率分别为79.31%(23/29)、20.69%(6/29),0~4分组分别为63.64%(35/55)、16.36%(9/55),2组间的完全缓解率(χ^2=2.183,P=0.140)和耐药率(χ^2=0.242,P=0.623)均差异无统计学意义。在5~6分组GTN病例中,耐药组患者年龄≥40岁占4/6,年龄<40岁占2/3,而所有敏感组患者的年龄均<40岁,2组年龄构成比差异有统计学意义,P=0.037。耐药组的终止妊娠距初次化疗的时间间隔平均(4.67±2.88)个月,敏感组则为(2.61±2.21)个月,差异有统计学意义,P=0.033。采用5-FU+KSM±VCR±Vp-16联合化疗方案治疗,5~6分组LRGTN的耐药率为0,MTX+KSM联合化疗方案耐药率为2/4,差异有统计学意义,P=0.037。5-FU+KSM±VCR±Vp-16联合化疗方案治疗5~6分组的LRGTN治愈率为100%(23/23),MTX+KSM联合化疗方案治愈率为4/6,差异有统计学意义,P=0.037。结论年龄≥40岁、终止妊娠与初次治疗的间隔时间较长是容易导致5~6分LRGTN患者对联合化疗耐药的高危因素。另外,5~6分的LRGTN患者可以首先考虑采用5-FU+KSM±VCR±Vp-16联合化疗方案。     

妊娠滋养细胞肿瘤药物治疗的现状及进展

妊娠滋养细胞肿瘤(GTN)是一类少见的恶性肿瘤，也是较早即可通过化疗治愈的肿瘤。国内外指南建议，在选择化疗方案的选择应依据于危险分层，低危GTN患者首选单药化疗。在2018年FIGO关于GTN诊治指南更新中，强调了对低危患者的进一步分层处理对于5～6分及病理诊断为绒癌的患者，单药化疗的耐药率增加，可以放宽标准直接选择联合化疗。随着肿瘤治疗的进展，新药物、新方法也在GTN中应用，但资料仍然比较有限。多重耐药、复发的GTN患者仍然是治疗的难点。对这些患者，大剂量化疗联合自体干细胞移植可能是一个治疗选择。免疫治疗的成功报道也是鼓舞人心的，有可能成为高危、耐药患者的新选择。不过，GTN的免疫检测点抑制剂的作用机制并不完全清楚，治疗的长期疗效或毒副反应、对远期生育力的影响尚不明确。免疫治疗在整个GTN治疗中的地位仍然需要探讨。     

MAC与EMA-CO方案治疗妊娠滋养细胞肿瘤肺转移的疗效对比分析

目的:对比评价两方案（MAC方案与EMA-CO方案）治疗妊娠滋养细胞肿瘤肺转移的疗效和毒副反应,以期为妊娠滋养细胞肿瘤肺转移化疗提供借鉴。方法:选择2009年6月至2013年12月的妊娠滋养细胞肿瘤肺转移患者124例作为研究对象,采用随机数字表法将其随机分为两组:治疗组和对照组,对照组予以EMA-CO方案治疗,治疗组MAC方案治疗,观察其疗效和副反应评价。结果:MAC方案组与EMA-CO方案组治疗妊娠滋养细胞肿瘤肺转移的完全缓解率分别为76.67%和71.88%,有效率分别为96.67%和100%;完全缓解率及有效率的比较经χ2检验,P＞0.05,差异无显著性意义,MAC方案低危型CR率明显高于EMA-CO方案,高危型CR率低于EMA-CO方案,组间比较差异均有统计学意义;MAC方案组血HCG降至正常时间及总疗程均较EMA-CO方案组少。两组患者恶心呕吐发生率、肝肾损伤发生率比较,P＞0.05,在统计学上无明显差异;但MAC组的骨髓抑制发生率和肝肾损伤发生率、严重程度及腹泻发生率、口腔溃疡发生率均低于EMA-CO组,P均<0.05,差异有统计学意义。另外,MAC方案组的复发率、平均住院日、化疗时间、费用等指标均较EMA-CO方案组少。结论:采用MAC方案治疗妊娠滋养细胞肿瘤肺转移的总体疗效与EMA-CO方案相当,MAC组重度骨髓抑制、胃肠道反应及口腔溃疡的发生明显少于EMA-CO组,并且疗程短,化疗时间及费用少,复发率低,患者更易于接受,依从性好,可以作为临床一线用药进一步推广。     

介入化疗在高危妊娠滋养细胞肿瘤治疗中的应用

目的:探讨介入化疗在高危妊娠滋养细胞肿瘤治疗中的应用。方法:2008年7月至2012年7月,在我院进行介入化疗的高危GTN患者21例。末次妊娠的性质来源于葡萄胎者10 例,流产后8例,中孕引产后1例,足月产后2 例。21例高危GTN患者均采用EMA-EP介入化疗方案, VP16 100mg/m2＋0.9%NS 40ml,d8介入;DDP 80mg/m2＋0.9%NS 100ml,d8介入。介入化疗前后均行妇科检查、彩色多普勒超声检查、胸部X 线或肺部CT 检查、血β-HCG 水平测定以明确诊断和进行疗效判定。结果:21例患者共行39次动脉插管,其中双侧子宫动脉插管24次,支气管动脉插管8次,左侧卵巢动脉插管2次,肠系膜下动脉插管2次,膀胱上动脉插管2次,阴部内动脉插管1次。介入化疗的有效率为95.2%。结论:介入化疗能提高高危GTN患者的化疗效果,降低化疗的耐药问题,有可能缩短治疗疗程,更重要的是可以保留脏器功能。对于高危GTN患者,介入化疗提供了新型、高效的方法。     

高危妊娠滋养细胞肿瘤的治疗进展

妊娠滋养细胞肿瘤（gestational trophoblastic neoplasms,GTN）是来源于胎盘部位滋养细胞的恶性肿瘤,好发于年轻女性,因对化疗高度敏感,治愈率高,其中高危型患者治愈率达80%～90%,但也有部分患者因发生耐药或复发,或者发生全身脏器如肝、脑等特殊部位转移而治疗无效。本文对高危型GTN临床治疗文献进行综述,总结该领域的研究进展。     

恶性滋养细胞肿瘤53例临床分析

目的 探讨恶性滋养细胞肿瘤的治疗及化疗方案的选择。方法 回顾性分析1993年2月至2001年10月收治的53例恶性滋养细胞肿瘤，I期30例，II期5例，Ⅲ期15例，Ⅳ期3例。实施5-FU KSM，EMA-CO方案，DDP MTX TX方案化疗，23例接受子宫切除术。结果 全组CR79.25%，PR16.98%，Ⅲ、Ⅳ度白细胞和血小板减少的发生率EMA-CO方案显著高于其他方案。结论 恰当的综合治疗有利于改善恶性滋养细胞肿瘤的预后，要重视EAA-CO方案的化疗毒副反应，不宜以EMA-CO方案取代传统的5-FU KSM方案。     

良恶性滋养层肿瘤的计算机图象判别

采用计算机图象分析系统,我们对30例良恶性滋养层肿瘤进行了定量检测。通过对15种参数的定量测定,发现细胞核的面积、周长、形状因子等9种参数可用于良恶性滋养层肿瘤的判别,尤其是葡萄胎和侵袭性葡萄胎的分辨率可达100%。本研究为通过刮宫样品鉴别侵袭性葡萄胎及葡萄胎提出了一种新的技术手段。     

Major surgeries performed for gestational trophoblastic neoplasms in a teaching hospital in Tehran, Iran

Objective

This study aim was to evaluate indications and outcomes of surgical interventions performed in patients with gestational trophoblastic neoplasm.

Methods

During January 1995 to December 2005, 110 patients with a diagnosis of persistent gestational trophoblastic neoplasm were treated in our Gynecologic Oncologic Department. Risk score calculation was carried out based on the revised FIGO 2000 scoring system for gestational trophoblastic neoplasm. Data from the patients'' records and pathologic reports were analyzed by the chi-square and Fisher''s exact tests and logistic regression. The Kaplan-Meier method including the log rank test was used to compare survival and recurrence.

Results

Eight patients did not complete their treatment and were excluded from the study. We evaluated treatment responses and outcomes in 102 patients. Seventy-nine patients (77.5%) responded fully to chemotherapy while 23 patients (22.5%) required surgery. Among 23 patients who underwent surgery, 10 cases (43.5%) had bleeding, and 13 cases (56.5%) had drug resistance. Several factors were found to be significantly different between the groups who responded to chemotherapy and those who needed surgery, including age (p=0.001), antecedent non-molar pregnancy (0.028), tumor stage (p=0.009), and pre-treatment risk scores (p=0.008). But, the total courses of chemotherapy (p=0.521), need to salvage chemotherapy (p=0.074), survival rates (p=0.714), and disease free survival rates (p=0.206) were not significantly different.

Conclusion

The data suggest that age, antecedent non-molar pregnancy, tumor stage and the prognostic score are clinical predictors of need for surgery. But, it dose not seem that surgery have any effect on the total course of chemotherapy, need for salvage chemotherapy, and patient prognosis.     

恶性滋养细胞肿瘤预后因素探讨

目的探讨不同治疗措施对恶性滋养细胞肿瘤预后的影响.方法对1994年1月～2000 年12月我院收治的58例恶性滋养细胞肿瘤患者的治疗措施及治疗效果进行回顾分析,随诊1～8年,比较刮宫次数≤2次或＞ 2以上、是否规范化疗及选择合理手术时机的治疗效果.结果恶性滋养细胞肿瘤患者刮宫次数≤2次与刮宫次数＞ 2次的疗效比较、是否选择合理手术时机的疗效比较差异均有显著性(P<0.05);不规范化疗与规范化疗的疗效比较差异有极显著性(P<0.01).结论正确的治疗措施即避免多次刮宫、进行规范化疗及选择合理手术时机是恶性滋养细胞肿瘤预后的重要影响因素.     

恶性滋养细胞肿瘤解剖分期和预后评分的临床意义

目的回顾性分析评价FIGO解剖分期和预后评分在GTT治疗中的临床意义。方法选择有比较完整临床资料的已治GTT患者90例,根据2000年FIGO分期和评分标准,进行解剖分期和预后评分,并据此比较治疗的效果。结果绒癌组高危比例37.8%,侵蚀性葡萄胎组高危比例17.3%。解剖分期为Ⅰ期和Ⅲ期的低危组患者疗效好于同期高危组患者(P<0.05)。在复发的6例患者中,1例为低危,5例属高危者。给予综合治疗的17例疗效满意。结论绒癌患者存在高危因素者多于侵蚀性葡萄胎。在同期别中,低危患者疗效要好于高危者。治疗时应同时参考解剖分期和预后评分并有效利用综合治疗。     

不同滋养细胞在恶性滋养细胞肿瘤中的分布

 应用免疫组化方法,采用抗细胞角蛋白(CK)、绒毛膜促性腺激素(hCG)、胎盘泌乳素(hPL)抗体,检测了91例恶性滋养细胞肿瘤不同类型滋养细胞的分布情况.结果显示,侵袭性葡萄胎和绒毛膜癌的滋养细胞组成不同.二者除了均具有较多合体滋养细胞(ST)外,前者中间型滋养细胞(IT)数量较后者明显增多,而后者细胞滋养细胞(CT)则较前者明显增多.转移性侵袭性葡萄胎与原发瘤在滋养细胞组成上无显著差异,但转移性绒毛膜癌ST较原发瘤明显增多,CT较原发瘤显著减少,IT数量虽有一定增加,但与原发瘤无显著差异.作者认为,合体滋养细胞在恶性滋养细胞肿瘤中的作用尚须进一步探讨.     

A New Type of Uterine Trophoblastic Tumor：Epithelioid Trophoblastic Tumor

Objective To describe a case of a patient with an epithelioid trophoblastic tumor (ETT) and review the literature regarding this new type of uterine trophoblastic tumor which is being reported with increasing frequency. There have been only 42 cases described in the world literature. Methods Routine sections of the tumor were prepared and stained with H&E. Using the SP method, immunohistochemical staining, for AE1/AE3, hPL, PLAP, and α-inhibin antigens was conducted. Results The patient was a 34 years old female who had delivered 12 years previously. She presented with amenorrhea for three months and vaginal irregular bleeding for 2 months. Her serum hCG level was 2,240 IU/L. After diagnostic curettage, an ETT was identified, and total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) performed. On microscopic examination it was found that the tumor was composed of chorionic-type intermediate-trophoblastic cells. The tumor cell nests were distributed in a geographical pattern. Some cells were filled with an eosinophilic hyalinized degenerative material. Study of the immunophenotype of the tumor showed that AE1/AE3, hPL, hCG, and α-inhibin were positively expressed. Conclusion This is the 4th case report of an ETT in China. The tumor was identified as a new type of trophoblastic tumor combined with a focal chorioepithelioid carcinoma, a condition that is extremely rare. It consists of chorionic-type intermediate-trophoblastic cells, and is considered to have a lowgrade of malignancy. ETT should be differentiated from a placenta-site trophoblastic tumor, placenta-site nodule, chorioepithelioid carcinoma, and cervical squamous cell carcinoma.     

子宫胎盘部位滋养细胞肿瘤临床病理分析

目的：分析5例子宫胎盘部位滋养细胞肿瘤（PSTT）的临床及病理特点．进一步提高诊断及治疗质量。方法：对5例PSTT进行临床、光镜及免疫组化的研究。结果：PSTT多数见于育龄妇女，前次妊娠葡萄胎3例，宫内妊娠2例，多数为阴道不规则出血，术前血清β—hCC达725～2240IU／L不等（正常值〈20IU／L）。光镜下均以种植部位中间滋养细胞（IT）为主，呈片块状或每索状穿插于子宫肌层平滑肌束间，常浸润血管壁，核分裂象〈2／10HPF或缺乏。免疫组化测定胎盘泌乳素（hPL）阳性，绒毛膜促性腺激素（hCG）呈阴性，须与正常妊娠胎盘床、胎盘超常反应、胎盘斑或结节、绒毛膜癌、上皮样滋养细胞肿瘤鉴别。结论：PSTT由胎盘种植部位中间滋养细胞组成，绝大多数县良性生物学行为，5例随访1～16年不等均健在。     

Multicenter Analysis of Gestational Trophoblastic Neoplasia in Turkey

Background: To evaluate the incidence, diagnosis and management of GTN among 28 centers in Turkey. Materials andMethods: A retrospective study was designed to include GTN patients attending 28 centers in the 10-year period betweenJanuary 2003 and May 2013. Demographical characteristics of the patients, histopathological diagnosis, the InternationalFederation of Gynecology and Obstetrics (FIGO) anatomical and prognostic scores, use of single-agent and multi-agentchemotherapy, surgical interventions and prognosis were evaluated. Results: From 2003-2013, there were 1,173,235 deliveriesand 456 GTN cases at the 28 centers. The incidence was calculated to be 0.38 per 1,000 deliveries. According to the evaluateddata of 364 patients, the median age at diagnosis was 31 years (range, 15-59 years). A histopathological diagnosis was presentfor 45.1% of the patients, and invasive mole, choriocarcinoma and PSTTs were diagnosed in 22.3% (n=81), 18.1% (n=66)and 4.7% (n=17) of the patients, respectively. Regarding final prognosis, 352 (96.7%) of the patients had remission, and 7(1.9%) had persistence, whereas the disease was mortal for 5 (1.4%) of the patients. Conclusions: Because of the differencesbetween countries, it is important to provide national registration systems and special clinics for the accurate diagnosis andtreatment of GTN.     

Epithelioid Trophoblastic Tumour: A Case with Genetic Linkage to a Child Born over Seventeen Years Prior,Successfully Treated with Surgery and Pembrolizumab

Epithelioid trophoblastic tumours are rare neoplasms showing differentiation towards the chorion leave-type intermediate cytotrophoblast, with only a handful of cases being reported in the literature. These tumours are slow-growing and are typically confined to the uterus for extended periods of time. While the pathogenesis is unclear, they are thought to arise from a remnant intermediate trophoblast originating from prior normal pregnancies or, less frequently, gestational trophoblastic tumours. A protracted time period between the gestational event and tumour development is typical. This case describes a 49-year-old previously healthy female who presented with a completely asymptomatic uterine mass, discovered incidentally during a routine gynaecological assessment. The pathological analysis of the hysterectomy specimen confirmed an epithelioid trophoblastic tumour, involving the uterus and cervix. This is a rare gynaecological tumour. A comparative short tandem repeat analysis revealed genetic similarities to a previous healthy gestation seventeen years prior. She was successful treated with adjuvant pembrolizumab, with no evidence of disease recurrence to date.