Objective: To summarize and analyze the clinical outcomes of gestational trophoblastic neoplasia (GTN) patients receiving primary treatment at Peking Union Medical College Hospital from 1985 to 2015, and investigate the changes in treatment efficacy between the first and the second 15 years. Methods: Clinical data of GTN patient receiving primary chemotherapy at Peking Union Medical College Hospital from January 1985 to December 2015 were retrospectively analyzed. It further compared the therapeutic results and chemotherapy cycles given to GTN patients, according to International Federation of Gynecology and Obstetrics (FIGO, 2000) prognostic score system, who were classified to different stages and low- or high-risk groups. Results: In total, 1 711 GTN patients were included in this study. Comparing the 1985-2000 group and the 2001-2015 group, the results showed that: (1) while the overall complete remission (CR) rate was 93.7% (1 603/1 711) , the CR rate of 2001-2015 group was significantly higher than that of 1985-2000 group [98.4% (1 155/1 174) vs 83.4% (448/537) , χ(2)=139.353, P<0.01]. This difference was significant between stage Ⅲ and Ⅳ patients, but nonexistent between stage Ⅰ and Ⅱ patients, including low- and high-risk groups. (2) The relapse rate of patients who had been in CR was 2.7% (43/1 603) , with no significant differences between the groups of 1985-2001 and 2001-2015 [3.6% (16/448) vs 2.3% (27/1 155) , χ(2)=6.867, P=0.142]. (3) The overall mortality rate was 2.6% (44/1 711) , which significantly decreased in 2001-2015 group compared to 1985-2000 group [1.6% (19/1 174) vs 4.7% (25/537) , χ(2)=13.830, P<0.01]. This difference appeared only in high-risk patients with stage Ⅲ disease (χ(2)=9.505, P<0.01) . (4) Fluorouracil was gradually replaced by floxridine in chemotherapy regimens. The total cycles of chemotherapy regimens given to low-risk patients with stage Ⅲ disease significantly decreased in 2001-2015 group, but no statistical difference was shown with patients at other stages. Moreover, the cycles of consolidation treatment were significantly reduced in patients with stage Ⅲ patients. Conclusions: GTN patients could obtain satisfactory curative results after appropriate and standard treatment. Peking Union Medical College Hospital has achieved better curative effect in the latest 15 years than before.
目的： 探讨初治妊娠滋养细胞肿瘤（GTN）患者的治疗效果及治疗情况的变化。 方法： 收集1985年1月—2015年12月期间在中国医学科学院北京协和医院接受初次治疗的GTN患者1 711例，其中前15年537例（1985—2000年组）、后15年1 174例（2001—2015年组）。比较两组患者的治疗效果，进一步比较不同国际妇产科联盟（FIGO，2000年）临床分期及预后评分的两组初治GTN患者的治疗效果，并对前、后15年初治GTN患者治疗情况（包括化疗方案和疗程数）的变化进行分析。 结果： （1）初治GTN患者的总完全缓解率为93.7%（1 603/1 711），其中2001—2015年组较1985—2000年组显著提高[分别为98.4%（1 155/1 174）、83.4%（448/537）；χ(2)=139.353，P<0.01）。进一步分析显示，临床分期为Ⅲ期（包括预后评分为0~6分和≥7分）、Ⅳ期患者中，2001—2015年组患者的完全缓解率均明显高于1985—2000年组（P<0.01）；而在Ⅰ、Ⅱ期（包括预后评分为0~6分和≥7分）患者中，两组患者的完全缓解率分别比较，差异均无统计学意义（P>0.05）。（2）初治完全缓解的1 603例GTN患者中，总复发率为2.7%（43/1 603），其中1985—2000年组和2001—2015年组分别为3.6%（16/448）和2.3%（27/1 155），两组比较，差异无统计学意义（χ(2)=6.867，P=0.142）。（3）初治GTN患者的总死亡率为2.6%（44/1 711），其中2001—2015年组较1985—2000年组显著下降[分别为1.6%（19/1 174）和4.7%（25/537）；χ(2)=13.830，P<0.01）。进一步分析显示，仅Ⅲ期高危（预后评分≥7分）患者的死亡率在两组中比较有明显差异（χ(2)=9.505，P<0.01），而两组间Ⅲ期低危（预后评分为0~6分）、Ⅳ期患者的死亡率分别比较，差异均无统计学意义（P>0.05）。（4）2001—2015年组与1985—2000年组相比，化疗方案中的氟尿嘧啶逐渐被氟脲苷取代，总化疗疗程数在Ⅲ期低危患者中显著减少（P<0.01）；其他临床分期（包括预后评分为0~6分和≥7分）患者的化疗疗程数在两组间分别比较，差异均无统计学意义（P>0.05）。 结论： 初治GTN患者在经过及时、规范的治疗后可以获得十分满意的疗效，随着诊疗技术的进步，近15年初治GTN患者的疗效较之前进一步提高。.
Keywords: Antineoplastic protocols; Gestational trophoblastic disease; Treatment outcome.