目的:探讨FAV方案（氟脲苷+放线菌素D+长春新碱）与Act-D（放线菌素-D）单次大剂量化疗方案用于一线化疗方案治疗低危型妊娠滋养细胞肿瘤（GTN）的效果。材料与方法:回顾性分析2005年1月-2017年1月在北京协和医院接受初始治疗为FAV方案或Act-D单次大剂量化疗方案共295例低危型GTN患者的临床资料,其中FAV方案（FAV组152例）、Act-D单次大剂量方案（Act-D组143例）,对比两组治疗方案的疗效。结果:FAV组和Act-D组达到血清学完全缓解（SCR）患者分别为 132 例和 108 例（86.8%vs 75.5%,p=0.013）。FAV 组和Act-D组对化疗耐药的患者分别为 15 例和 35 例（9.9%vs 24.5%,p=0.001）,因不能耐受化疗副反应而需更改化疗方案者分别为5例和0例（3.2%vs 0%,p=0.029）。两组耐药或不能耐受副作用患者中3例失访,1例疾病稳定（SD）,其余均通过更换化疗方案后获得SCR。FAV组有2例复发,Act-D组有 3 例复发（1.3%vs 2.1%,P=0.604）。FAV 组和 Act-D 组平均总疗程数分别为4.7程和5.2程（p=0.007）,血HCG降至正常的平均疗程数分别为2.5程和3.3程（P=0.000）,平均巩固疗程数分别为2.2程和2.0程（P=0.088）,平均总治疗时间分别为105天和79天（p=0.000）。在进行FIGO（0-4分）亚组分析中,FAV组和Act-D组平均总疗程数分别为4.5程和5.2程（p=0.000）,血hCG降至正常的平均疗程数为2.3程和3.3程（p=0.000）,平均巩固疗程数分别为2.2程和2.0程（P=0.100）,平均总治疗时间分别为101天和78天（P=0.000）,SCR率分别为86.1%和76.6%（p=0.051）,耐药率分别为9.8%和23.4%（p=0.004）,复发率分别为1.6%和2.1%（p=0.388）。在进行葡萄胎后GTN亚组分析中,FAV组和Act-D组SCR率分别为88.5%和 75.9%（p=0.010）,在 FIGO（0-4 分）中,SCR 率分别为 89.1%和 75.9%（p=0.009）。结论:FAV方案及Act-D单次大剂量方案作为低危型GTN治疗方案均为有效,FAV方案较Act-D单次大剂量方案治愈率更高且耐药率更低,在葡萄胎后GTN患者中更为显著,但其治疗时间长于Act-D单次大剂量方案,且耐受性差于Act-D单次大剂量方案。对于FIGO评分0-4分,两种方案治愈率上无明显差异,但Act-D单次大剂量方案虽然耐药率较高,但治疗时间更短且耐受性更好。

Objective: To investigate and compare the effect of FAV regimen (fluorourea glycoside+actinomycin D+vincristine) and pulse Act-D (actinomycin-D ) regimen as a first-line chemotherapy in the treatment of low -risk gestational trophobla stic tumors(GTN ).
Methods: The clinical data of 295 patients with low-risk GTN who received FAV or pulse Act-D chemotherapy in Peking Union Medical College Hospital from 2005 to 2017 were letrospectively analyzed , including 152 patients in FAV group and 143 patients in Act-D group.
Results : of 295 patients, 240(81.4% ) patients achieved serological complete remission (SCR ) after the first-line chemotherapy with FAV or pulse Act-D regimen, including 132 patients in FAV group and 108 patients in Act-D group (86.8% and 35 cases (9.9% vs 24.5% , p=0.001) were resistant to chemotherapy, and 5 cases and 0 cases (3.2% vs 0%, p =0.029) were changed to other chemotherapy regimens because of in to lerance to adverse side effects . Among patients whether resistant or intolerant to chemotherapy regimen, 3 cases was lost to follow -up and 1 case was stable disease , the remaining received SCR after changing the chemotherapy regimen. There were 2 recurrences in FAV group and 3 recurrences in Act-D group, respectively (1.3% vs 2.1% , p=0.604). The mean total course of treatment in FAV group and Act-D group was 4.7 and 5.2 (p=0.007), the mean course of HCG normalization was 2.5 and 3.3 (p=0.000), and the mean consolidation course was 2.2 and 2.0 (p=0.088).The mean treatment time length was 105 days and 79 days (p=0.000).In subgroup analysis with FIGO score of 0-43 SCR was achieved 86.1% and 76.6%(p=0.051) in FAV group and Act-D group, respectively. The meantotal course of treatment in FAV group and Act-D group was 4.5 and 5.2 (p=0.000)3 the mean course to achieve HCG normalization was 2.3 and 3.3 (p=0.000), and the mean consolidation course was 2.2 and 2.0 (p=0.100), while the mean treatment time length was 101 days and 78 days (p=0.000). The drug resistant rate was 9.8% and 23.4% (p =0.004), and the recurrence rate was 1.6% and 2.1% (p=0.388). In subgroup analysis of GTN after hydatidiform mole, we found more significant difference in SCR rates of FAV group and Act-D group, with 88.5% and 75.9%(p=0.010), respectively. while after restricted FIGO score to 0-4, the SCR rates in FAV group and Act-D group were 89.1% and 75.9% (p=0.009).
Conclusion: Both FAV and pulse Act-D regimens are effective in the treatment of low-risk GTN. compared to pulse Act-D regimen, FAV regimen has higher curative ratio and lower drug resistance rate, Additionaly, the difference is more significant in patients with GTN after hydatidiform mole. However, the former regimen demands longer time to cure, and has poorer tolerance than the latter regimen. what's more, In subgroup with FIGO score 0-4, there is no significant difference in the curative ratio between the two regimens, while the regimen of pulse Act-D has higher drug resistance rate, it takes shorter time to treat and has better tolerance.