EFFECTS OF MULTIAGENT CHEMOTHERAPY AND INDEPENDENT RISK-FACTORS IN THE TREATMENT OF HIGH-RISK GTT - 25 YEARS EXPERIENCES OF KRI-TRD

A retrospective and comparative study of high-risk gestational trophob lastic tumor (GTT) treated with different chemoregimen from 1971 to 19 95 was performed and to find most effective chemotherapy regimen and i ndependent risk factors.Three hundred seven patients in scoring over 8 points in WHO classification were categorized into high-risk group am ong 802 GTT cases received chemotherapy in the 2,418 GTD patients regi stered at KRI-TRD (Korean Research Institute for Gestational Trophobla stic Disease), Catholic University Medical College in Korea. Study gro ups of multiagent combination chemotherapy in 227 patients of the high -risk GTT were divided such as 49 cases of combination chemotherapy wi th MTX + folinic acid acid Act-D, 40 cases of MAC regimen, 42 cases of CHAMOCA regimen, and 96 cases of EMA/CO. Initial tumor response accor ding to hCG titer decrease was found in good response (log fall) 69.8% , of EMA/CO regimen group. On the other hand, good response was shown in only 24.5% of MTX + ACT-D, 32.5% of MAC regimen, and 52.4%, of CHAM OCA regimen respectively. Remission rate of EMA/CO regimen was 90.6% ( 87/96) and courses of chemotherapy until remission was 85 +/- 2.2. How ever, remission rate of other regimens of MTX + Act-D, MAC, and CHAMOC A were 63.3%, (31/49) 67.5% (27/40) and 76.2% (32/45) respectively, wi th 10.0 +/- 4.0, 10.7 +/- 4.3, 9.1 +/- 3.9 chemotherapy courses respec tively until remission. Therefore, EMA/CO regimen groups were found to have low drug toxicity, early remission and a low failure rate. In th e study of independent risk factors in the 165 cases of high-risk gest ational trophoblastic tumor patients received EMA/CO regimen, stepwise Coxs proportional hazard's regression of prognostic factors using mul tivariate analysis revealed tumor age, number of metastatic organs, me tastatic site and inadequate previous chemotherapy. According to the p erformance of fitted logistic regression model, the prediction rate of death and survival was 80.5%. Conclusions: The most effective chemoth erapy to high-risk GTT was EMA/CO regimen than other regimens. The fol lowing factors showed poor prognosis; 1) Tumor age is over 12 month, 2 ) more than 2 organs had metastatic lesion, 3) inadequate previous the rapy that includes unplanned operation and inadequate previous chemoth erapy.