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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。
Objective To investigate the clinical efficacy of vincristine + actinomycetes D + etoposide + floxuridine (FAEV) in the treatment of high-risk gestational trophoblastic tumor (GTN). Methods Thirty-eight patients with high-risk GTN who underwent primary chemotherapy between January 2011 and December 2012 were divided into experimental group and control group according to the random number table method, with 19 cases in each group. Patients in the experimental group received FAEV regimen chemotherapy, and patients in the control group received 5-Fu + KSM regimen chemotherapy. The clinical efficacy, duration of treatment and side effects were compared between the two groups. Results The serological s CR rate, drug resistance (NR) and recurrence rate (REC) in the experimental group were 78.9%, 21.1% and 0.0% respectively, while those in the control group were 57.9% and 26.3% respectively And 5.3% respectively, all of which were statistically significant (P <0.05). Among the patients in the experimental group, s CR was obtained after 3 cases of NR were treated with actinomycin D + methotrexate + cyclophosphamide + vincristine + VP16 (EMA-CO). In the control group, 6 patients with NR received SCR after switching to chemotherapy with EMA-CO regimen. In the control group, 2 patients with REC were treated with surgical resection and then received sCR after chemotherapy with EMA-CO regimen. In the experimental group, the β-h CG decreased to ≤2 U / L, there was no significant difference between the two groups (P> 0.05). The incidence of oral ulcer and diarrhea in the experimental group was 5.3% and 10.5% respectively, while that in the control group was 84.2% and 68.4% respectively, with significant difference (P <0.05). Conclusions The treatment of high-risk CTN with FAEV chemotherapy has a significant effect and low incidence of adverse reactions.