Objective: This study aimed to compare the clinical efficacy and safety of a combination of methotrexate (MTX) plus calcium folinate (CF) and actinomycin D (ACT-D) treatment in patients with low-risk trophoblastic tumors. Methods: We included 95 and 101 patients who received chemotherapy with MTX plus CF (MTX + CF group) and ACT-D (ACT-D group). The cure rate, drug resistance rate, number of treatment courses, and adverse reactions were compared between both groups. Results : Age, International Federation of Gynecology and Obstetrics (FIGO) stage and score, prechemotherapy β-human chorionic gonadotropin (HCG) levels, and the nature of the last pregnancy were associated with the development of resistance. Furthermore, age, FIGO stage III, and a hydatidiform mole in the last pregnancy were independent risk factors for gestational trophoblastic neoplasia (GTN) after MTX + CF or ACT-D chemotherapy (P < 0.05). Both MTX + CF and ACT-D had a high cure rate and a low rate of resistance in gestational trophoblastic tumors. The adverse reaction incidence was lower in the MTX + CF group than in the ACT-D group. Conclusions: Advanced age, FIGO stage III, and a hydatidiform mole in the last pregnancy may be associated with the development of resistance to MTX + CF or ACT-D chemotherapy in patients with gestational trophoblastic tumors.

目的：本研究旨在比较甲氨蝶呤（MTX）加亚叶酸钙（CF）和放线菌素D（ACT-D）联合治疗低危滋养细胞肿瘤的临床疗效和安全性。方法：我们纳入了95例和101例接受MTX加CF（MTX + CF组）和ACT-D（ACT-D组）化疗的患者。比较两组的治愈率，耐药率，疗程数和不良反应。结果：年龄，国际妇产科联合会（FIGO）分期和评分，化疗前β-人绒毛膜促性腺激素（HCG）的水平以及最后一次妊娠的性质与耐药性的发展有关。此外，MTX + CF或ACT-D化疗后，年龄，FIGO III期和最后一次妊娠的葡萄胎是妊娠滋养细胞性肿瘤（GTN）的独立危险因素（P  <0.05）。MTX + CF和ACT-D在妊娠滋养细胞肿瘤中均具有较高的治愈率和较低的耐药率。MTX + CF组的不良反应发生率低于ACT-D组。结论：妊娠滋养细胞肿瘤患者的高龄，FIGO III期和最后一次妊娠的葡萄胎可能与对MTX + CF或ACT-D化疗产生耐药性有关。