Objective: To evaluate treatment outcomes and prognostic factors in patients with ultra-high-risk gestational trophoblastic neoplasia (GTN) compared to those with low-risk and high-risk GTN.Methods: A retrospective review of medical records was conducted for GTN patients treated at Chiang Mai University Hospital, Chiang Mai, Thailand, between January 1999 and December 2019. Overall and risk-specific survival rates were estimated using the Kaplan–Meier method, and prognostic factors were analyzed through univariate and multivariate analyses.Results: During the study period, 160 patients with GTN were identified, including 98 (61.2%) classified as low-risk, 31 (19.4%) as high-risk, and 31 (19.4%) as ultra-high-risk. One patient in the low-risk group and one in the high-risk group underwent hysterectomy without adjuvant chemotherapy due to spontaneous regression of serum β-hCG (human chorionic gonadotropin). Additionally, one patient with ultra-high-risk GTN died before receiving chemotherapy. Among the 97 low-risk GTN patients, 80 (82.5%) were treated with either single-agent methotrexate or actinomycin D. Among the 30 high-risk GTN patients, 20 (66.7%) received EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) as first-line chemotherapy, while 24 (80%) of the 30 ultra-high-risk GTN patients received EMA/CO as first-line treatment. Following first-line chemotherapy and/or salvage treatment, patients with ultra-high-risk GTN had significantly worse outcomes compared with those with low- and high-risk GTN, with remission rates of 63.3%, 96.9%, and 80.0%, respectively (p< 0.01). The five-year overall survival rate for patients with ultra-high-risk GTN was significantly lower than that for patients with low- and high-risk GTN (56% vs. 96% and 80%, respectively;p< 0.001). On multivariable analysis, significant prognostic factors included antecedent term pregnancy (hazard ratio [HR] = 11.50; 95% confidence interval [CI], 3.56–37.22;p< 0.01) and brain metastasis (HR = 4.61; 95% CI, 1.73–12.28;p< 0.01).Conclusions: Ultra-high-risk GTN accounts for only a small proportion of GTN cases but it is associated with poor survival rate and responsible for the majority of GTN-related deaths. Antecedent term pregnancy and brain metastasis were identified as significant prognostic factors.
目的：比较超高危妊娠滋养细胞肿瘤（GTN）患者与低危和高危GTN患者的治疗结局及预后因素。 方法：回顾性分析1999年1月至2019年12月在泰国清迈大学医院接受治疗的GTN患者病历资料。采用Kaplan-Meier法评估总体及不同风险分层的生存率，并通过单变量和多变量分析探讨预后因素。 结果：研究期间共纳入160例GTN患者，其中低危98例（61.2%）、高危31例（19.4%）、超高危31例（19.4%）。低危组和高危组各1例患者因血清β-hCG（人绒毛膜促性腺激素）自发消退，仅行子宫切除术而未接受辅助化疗。另有1例超高危GTN患者在化疗前死亡。在97例低危GTN患者中，80例（82.5%）接受甲氨蝶呤或放线菌素D单药治疗；30例高危GTN患者中，20例（66.7%）以EMA/CO方案（依托泊苷、甲氨蝶呤、放线菌素D、环磷酰胺及长春新碱）作为一线化疗；30例超高危GTN患者中，24例（80%）采用EMA/CO方案作为一线治疗。经一线化疗和/或挽救治疗后，超高危GTN患者的缓解率显著低于低危和高危患者（分别为63.3%、96.9%和80.0%，p<0.01）。超高危GTN患者的五年总生存率显著低于低危和高危患者（56% vs. 96%和80%，p<0.001）。多变量分析显示，足月妊娠史（风险比[HR]=11.50；95%置信区间[CI] 3.56–37.22；p<0.01）和脑转移（HR=4.61；95% CI 1.73–12.28；p<0.01）是显著预后因素。 结论：超高危GTN在GTN病例中占比虽小，但其生存率低，是导致GTN相关死亡的主要原因。足月妊娠史和脑转移被确定为重要预后因素。
肿瘤(癌症)患者之家