The efficacy evaluation of initial chemotherapy for high-risk gestational trophoblastic neoplasm

In clinical practice, a large number of patients have failed to receive chemotherapy or combination therapy because of drug resistance, recurrence and metastasis of specific sites. Therefore, how to choose the initial chemotherapy individually and reduce the occurrence of drug resistance is the key to cure high-risk GTN. This study investigated the efficacy of chemotherapy based on 5-fluorouracil (5-FU) regimen and EMA/CO regimen as the initial chemotherapy regimen in the treatment of high-risk gestational trophoblastic neoplasms (high-risk GTN). The treatment status of high-risk GTN patients who received primary chemotherapy using 5-Fu regimens (FAV and FA regimens) or EMA/CO regimens at Cancer Hospital of China Medical University from 2002 to 2019 was retrospective analyzed. Regular follow-up was conducted to evaluate its efficacy and to analyze prognostic factors. There were a total of 87 high-risk patients, 75 in the 5-FU-based group and 12 in the EMA/CO group. The clinical characteristics of patients in both groups were not statistically significant (P > 0.05). The overall survival rate of all patients was 87.4%, the rate of serological complete remission (SCR) was 87.4%, the SCR rate of initial treatment was 75.9%, the recurrence rate was 7.9%, and the mortality rate was 12.6%. There were no statistical differences in overall survival rate, SCR rate, SCR rate of initial treatment, drug resistance rate, recurrence rate and mortality in the 5-FU group and the EMA/CO group (P > 0.05). The median follow-up was 106 months. Kaplan-Meier analysis showed that the 1-year survival rate, 5-year survival rate and 10-year survival rate in the 5-FU group were 91.9%, 84.3% and 84.3% respectively. The 1-year survival rate, 5-year survival rate and 10-year survival rate of the EMA/CO group were all 91.7%, and there was no statistical difference in the overall survival time between the 2 groups (P > 0.05). COX proportional stepwise regression analysis showed that only clinical staging was an independent risk factor of the prognosis of high-risk GTN (P = 0.003). Conclusion Both 5-FU regimen and EMA / CO regimen can be used as the first-line treatment for high-risk GTN patients, and their effects are similar. For high-risk GTN patients with drug resistance, EMA / CO, FAEV and PEB can be used as second-line salvage chemotherapy.