KẾT CỤC ĐIỀU TRỊ BỆNH LÝ TÂN SINH NGUYÊN BÀO NUÔI KHÁNG METHOTREXATE TẠI BỆNH VIỆN TỪ DŨ

Abstract

Background: Gestational trophoblastic disease (GTD) is a group of diseases with a good prognosis. Most patients who are resistant to initial chemotherapy still have a good response to alternative single-agent chemotherapy regimens, which limit side effects. In contrast, the EMACO multi-agent regimen offers a higher success rate but causes more side effects. Determining the success rate of alternative chemotherapy regimens and prognostic factors is essential to provide information for clinicians and improve treatment outcomes. Objective: To determine the success rate of alternative chemotherapy regimens in patients with GTD who failed methotrexate (MTX) chemotherapy at Tu Du Hospital and the related factors. Methods: A retrospective cohort study was conducted on 124 MTX-resistant GTD patients from January 2018 to December 2023 at Tu Du Hospital. Results: The success rate of alternative chemotherapy was 89.52%. Thirteen out of 124 cases required salvage chemotherapy, with a salvage chemotherapy rate of 16.67% in the Act-D group and 3.44% in the EMACO group. Based on multivariate regression analysis, GTD patients with fewer than four cycles of MTX chemotherapy had a 4.17-fold increased risk of failure with alternative chemotherapy (p<0.05); the Act-D alternative chemotherapy regimen had a 9.09-fold higher risk of requiring salvage chemotherapy compared to the EMACO group (p<0.05). Conclusion: The success rate of alternative chemotherapy is 89.52%, with factors such as the number of MTX chemotherapy cycles and the type of alternative chemotherapy regimen (Act-D) being prognostic factors for failure.