Objective: This study aims to evaluate the efficacy of EMA-CO as an initial regimen for high-risk gestational trophoblastic neoplasia and to analysis the influenced factors. Methods: A total of 81 patients with high-risk gestational trophoblastic neoplasia (HRGTN) treated in Women Hospital Affiliated Zhejiang University from Jan 2007 to Jan 2017 whose primary chemotherapies were EMA-CO were enrolled.The International Federation of Gynecology and Obstetrics (FIGO) prognosis score of all the patients was ≥7.The relationships of different factors were analyzed by univariate and multivariate analysis. Results: Fifty-five of 81 patients (67.90%) achieved complete primary remission with single EMA-CO regimen, 12 patients (14.81%) achieved complete primary remission with EMA-CO regimen and surgery, and 14 patients (17.28%) achieved drug resistance.The univariate and multivariate analysis showed that the FIGO score (P=0.004, OR 1.336, 95%CI 1.099-1.623) was an independent predictive factor for the outcome of EMA-CO regimen. Conclusions: EMA-CO is the first-line regimen used to treat patients with HRGTN. Salvage therapies such as EMA-EP regimen and adjuvant surgery are still effective treatments. The FIGO score is an independent risk factors for the outcome of EMA-CO regimen.
目的： 旨在分析依托泊苷＋甲氨蝶呤＋放线菌素D/环磷酰胺＋长春新碱(EMA－CO)方案初始化疗对高危型妊娠滋养细胞肿瘤(GTN)患者的疗效及相关因素分析。 方法： 收集浙江大学医学院附属妇产科医院2007年1月至2017年1月收治的81例高危型GTN患者，根据国际妇产科联盟(FIGO)的预后评分，81例患者评分均≥7分，所有患者初始化疗方案为EMA－CO，对其临床特点及其疗效进行单因素和多因素分析。 结果： 81例患者中55例(67.90%)经单纯EMA－CO化疗后达到完全缓解，12例(14.81%)经EMA－CO联合手术达到完全缓解。14例(17.28%)出现耐药。单因素(P＝0.002)与多因素分析(P＝0.004，OR 1.336，95%CI 1.099～1.623)均显示FIGO预后评分≥12分是EMA－CO耐药的独立影响因素。 结论： EMA－CO是高危型GTN患者有效的联合化疗方案，对EMA－CO耐药的GTN患者，补救性治疗如足叶乙甙＋甲氨蝶呤＋放线菌素D/足叶乙甙＋顺铂(EMA－EP)联合化疗或手术仍然是有效的治疗方式。FIGO预后评分是EMA－CO耐药的独立影响因素。.
Keywords: Chemotherapy; EMA-CO regimen; Gestational trophoblastic neoplasia; Primary regimen.