低危型妊娠滋养细胞肿瘤治疗热点

临床对于低危型妊娠滋养细胞肿瘤(GTN)患者的首选治疗方案为单药化疗，常用药物为甲氨喋呤(MTX)与放线菌素-D(Act-D)。目前多数研究认为，Act-D单药化疗对于低危型GTN患者的疗效优于MTX，但是该类研究纳入的样本量与质量均不够高，尚需更多大样本、多中心随机对照试验研究、证实。虽然低危型GTN患者经单药化疗后，预后普遍较好，然而越来越多研究结果表明，根据国际妇产科联盟(FIGO)制定的《妊娠滋养细胞肿瘤临床分期与预后评分系统(FIGO 2000)》，评分为5～6分及存在转移的低危型GTN患者，对一线单药化疗方案的反应率较低，因此该类患者是否首选联合化疗方案治疗，值得探讨。笔者拟就低危型GTN的主要化疗方案、MTX及Act-D治疗低危型GTN的优势与劣势，以及低危型GTN的其他治疗策略，如2次清宫术、全子宫切除术、期待疗法的最新研究进展进行阐述，旨在为临床医师诊治该病提供参考。

Hotspots of low-risk gestational trophoblastic neoplasia treatment

Single-agent chemotherapy is the preferred treatment for patients with low-risk gestational trophoblastic neoplasia (GTN), and the commonly used drugs are methotrexate (MTX) and actinomycin-D (Act-D). At present, most studies show that Act-D single-agent chemotherapy is more effective than MTX in treatment of low-risk GTN patients, but the samples sizes and qualities of these studies are insufficient, and more large samples, multi-center randomized controlled trials are needed to confirm the conclusions. Although low-risk GTN has a generally good prognosis after single-agent chemotherapy, more and more studies have shown that low-risk GTN patients who got 5-6 scores from Clinical Staging and Prognosis Scoring Systems for Gestational Trophoblastic Neoplasia (FIGO 2000) by the International Federation of Gynecology and Obstetrics (FIGO) or had metastasis shown poor response to the first-line single-agent chemotherapy. Therefore, it is worth exploring whether the combination chemotherapy is the first choice for these patients. This review focuses on elaborating the major chemotherapy regimens of low-risk GTN, the advantages and disadvantages of MTX and Act-D in the treatment of low-risk GTN, as well as other treatment strategies of low-risk GTN, such as second curettage, total hysterectomy and expectant therapy, in order to provide a reference for clinicians to diagnose and treat the disease.