Objective To construct the replication-deficient recombinant adenoviruses vectors contained human TNFα gene and to investigate TNFα expression in human umbilical cord blood-derived mesenchymal stem cells(hUCB-MSCs). And to observe the drug-resistance changes of JEG-3/VP16 after co-culture with hUCB-MSCs transfected with adenovirus-mediated hTNFα gene. Method Human TNF-α gene was amplified by PCR method from plasmid pCMV-SPORT6-TNF and cloned into shuttle vector pDC316-IRES-EGFP which was carried into 293 cells together with backbone plasmid pBHGlox_E1,3Cre by lipofectamine 2000 to obtain packed recombinant adenovirus Ad-TNFα. hUCB-MSCs were isolated,cultivated and identified in vitro. The resistance index of JEG-3/VP16 was determined by MTT test after co-culture with hUCB-MSCs transfected with hTNFα gene. Result (1)The packed recombinant adenovirus Ad-TNFα was identified using PCR and enzyme digestion.(2)The adenovirus vector was constructed successfully and high efficient expression of TNFα in hUCB-MSCs was detected. (3)MTT test showed that the resistance index of JEG-3/VP16 decreased after co-culture with hUCB-MSCs transfected huTNF-α gene. Conclusion The drug resistance of JEG-3/VP16 can be reversed after co cultured with hUCB-MSCs transfected with hTNFα gene.

Objective To distinguish choriocarcinoma from gestational or non-gestational choriocarcinoma and also identify the causative pregnancy of gestational choriocarcinoma by the genetic origin through molecular genetic analysis. Methods Twelve patients with choriocarcinoma, who had experienced surgery prior to chemotherapy were enrolled in this study. All 12 cases were diagnosed pathologically as choriocarcinoma. Peripheral venous blood samples and formalin-fixed paraffin-embedded blocks of choriocarcinoma tissue microdissected from haematoxylin and eosin-stained sections of tissue by microdissection method were available from the patient and (or) her husband. DNA was then prepared from the couples' blood samples and choriocarcinoma tissue by using standard techniques. PCR amplification and fluorescent microsatellite genotyping were performed by using DNA from the couples and captured choriocarcinoma tissues. The genetic contributions to the choriocarcinoma tissue were determined by comparing the fragments of genes from the choriocarcinoma tissue to those from blood samples of the couples. Results The primary lesion was ovary in 7 cases, but only 4 of them had the maternal contribution, indicating a non-gestational origin; the other three were gestational choriocarcinoma. The primary lesion was uterus in 5 cases, which were all gestational choriocarcinoma confirmed by genetic analyses. The causative pregnancies of the 8 cases with gestational choriocarcinoma were identified as androgenetic complete hydatidiform mole (AnCHM) in six cases and normal pregnancies in two cases, respectively. Conclusion Microsatellite polymorphism analysis is a molecular approach for distinguishing the non-gestational choriocarcinoma from the gestational one, and also be used to identify the causative pregnancy of gestational choriocarcinoma.

INTRODUCTION:The objective of the study was to investigate the clinical characters, diagnosis, treatment, and prognosis of nongestational ovarian choriocarcinoma. METHODS:A retrospective analysis was done on 21 patients with nongestational ovarian choriocarcinoma treated in Peking Union Medical College Hospital from January 1985 to October 2008. All patients' conditions were diagnosed by histopathologic examination; in 3 of them, the diagnosis was confirmed by DNA polymorphism analysis at 12 short tandem repeat loci. RESULTS:Correct diagnosis was achieved in only 3 patients before initial treatment. All patients received standard multiple-drug combined chemotherapy and underwent an operation. The mean number of chemotherapy courses for each patient was 10. Of the 21 patients, 16 achieved complete remission, and 4 obtained partial remission; 1 died. In a median follow-up of 71.4 months, the 5-year overall survival rate was 79.4%. CONCLUSIONS:The early diagnosis of nongestational ovarian choriocarcinoma is expected to be improved. DNA polymorphism analysis is a useful tool in determining the origin of ovarian choriocarcinoma. The prognosis is optimistic if managed with standard multiple-drug chemotherapy combined with surgical treatment.

The objective of this study was to evaluate the influence of surgical resection on survival outcome in patients with gestational trophoblastic neoplasia with pulmonary metastatic disease. Medical records of 62 patients with gestational trophoblastic neoplasia who underwent pulmonary lobectomy or limited resection were reviewed. The cases were divided into 3 groups, namely, the recurrent group (group A), the drug-resistant group (group B), and the group with satisfactory response to chemotherapy but with residual pulmonary lesion (group C). The proportion of high-risk patients was significantly lower in group C, whereas this group had a remarkable complete remission rate of 100% with no relapse recorded, and only 3 patients (12.0%) in this group had a positive histologic diagnosis. The complete remission rates of groups A and B were 88.9% and 78.6%, respectively, and the relapse rates were 14.3% and 15.0%, respectively. By comparing treatment failure cases with patients who achieved complete remission, factors that might affect the clinical outcome of pulmonary surgery were also analyzed. Patients who have received more than 4 regimens or 13 courses of preoperative chemotherapy seemed to have unfavorable prognosis (P < 0.05). Follow-ups could be carried out without surgical resection for patients with satisfactory response to chemotherapy but with residual pulmonary lesions. Pulmonary surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug-resistance and the lesions are relatively localized. However, surgery is not advisable for patients who received more than 4 regimens or 13 courses of preoperative chemotherapy.

Objective. Several studies have reported that surgical management of chemotherapy-resistant gestational trophoblastic neoplasia (GTN) is a useful adjunct to chemotherapy. We investigated the pretreatment predictive factors of therapeutic response in response to surgical management combined with chemotherapy.Methods. The study involved 61 patients with chemotherapy-resistant GTN who underwent surgery between January 1996 and January 2007. Responses to the combination therapy with surgery and chemotherapy were assessed after the end of treatment. Statistical analyses were performed to identify preoperative clinical factors associated with response of chemotherapy-resistant GTN.Results. After the end of combination therapy, 47 (77.0%). 4 (6.6%), 1 (1.6%), and 9 (14.8%) of 61 patients showed complete response (CR), partial remission (PR), stable disease (SD), and progressive disease (PD), respectively. Univariate analysis found that predictors of response were age (p = 0.022), antecedent pregnancy (p = 0.022), site of metastasis (p = 0.026), and preoperative serum human chorionic gonadotropin-beta subunit (beta-hCG) level (p = 0.027). All patients with treatment failure had 2 or more of unfavorable factors, including age older than 35 years, antecedent non-molar pregnancy, distant metastasis Outside of lungs and uterus. and preoperative serum beta-hCG level greater than 10 IU/L.Conclusions. The data Suggest that age older than 35 years, antecedent non-molar pregnancy, distant metastasis outside of lungs and uterus, and a preoperative serum beta-hCG level greater than 10 IU/L are important clinical predictors of treatment failure to Surgery. They may benefit in the selection of salvage surgery as well as the assessment of individual prognosis. (C) 2009 Elsevier Inc. All rights reserved.

Objective:To compare the occurrence rate and severity degree of adverse reactions of floxuridine(FUDR)-containing regime and 5-fluorouracil(5-FU)-containing regime in the treatment of patients with gestational trophoblastic disease.Methods:A retrospective analysis was carried out in patients diagnosed as gestational trophoblastic disease in 2000 and 2005,respectively.Their medical charts were reviewed especially those patients treated with fluoropyrimidine-containing regime.The symptoms including nausea or vomiting,diarrhea and myelosuppression were recorded as the adverse reactions and graded for severity according to the NCI-CTC scale.Results:There was no difference on incidences of grade Ⅲ/Ⅳ diarrhea,leucopenia,neutropenia,thrombocytopenia between FUDR-containing two-drug regime and 5-FU-containing two-drug regime.The incidences of grade Ⅲ/Ⅳ nausea or vomiting of FUDR were significantly greater than those in treatment-naive patients after the administration of 5-FU-containing two-drug regime.There was no difference on incidences of grade Ⅲ/Ⅳ diarrhea between FUDR-containing three-drug regime and 5-FU-containing three-drug regime.The incidences of grade Ⅲ/Ⅳ nausea or vomiting,neutropenia of FUDR were significantly greater than those in treatmentnaive patients after the administration of 5-FU-containing three-drug regime.The incidences of grade Ⅲ/Ⅳ hematological toxicity of FUDR were significantly higher than those in the patients with 5-FU containing three-drug regime.Conclusion:The incidences of grade Ⅲ/Ⅳ nausea,vomiting and hematological toxicity of FUDR-containing regime were greater than those after the administration of 5-FU-containing three-drug regime.

OBJECTIVE To investigate the genetic polymorphism of dihydropyrimidine dehydrogenase gene(DPYD) in the patients with gestational trophoblastic disease.METHODS The polymerase chain reaction(PCR)-DNA sequencing technique was used to identify 5 mutation points of DPYD,including A74G,T85C(DPYD*9),IVS14+1G→A(DPYD*2),C2303A and A2846T. Exon 4,5,6,7,8,10,11,12,13,21,and 23 were also analyzed in the patients with DPD activity deficiency or suffering from severe toxicity after the administration of fluoropyrimidines.RESULTS Among 130 enrolled subjects,105 of them were treated with fluoropyrimidines-containing regime,25 were follow-up who had been suffered severe toxicity with fluoropyrimidinescontaining treatment.DPYD*2,DPYD*9,A496G,A1627G and C2303A mutations were found;while 2 novel silent mutations, A720C and A2670C,were detected.The allelic frequencies of DPYD*9 and C2303A were 6.93%and 0.49%in treatment group, respectively.The allelic frequencies of DPYD*2,DPYD*9,A496G,A720C,A1627G,C2303A and A2670C were 1.14%,7.95%, 3.41%,37.50%,18.18%,1.14%and 15.91%in the patients with DPD deficiency and follow-up group.CONCLUSION DPYD*2, DPYD*9,A496G,A720C,A1627G,C2303A and A2670C were found.DPYD*2 and C2303A may be associated with DPD deficiency.

Objective:To determine the dihydropyrimidine dehydrogenase (DPD) activity in patients with gestational trophoblastic disease (GTD),and analyze the relationship of dihydropyrimidine dehydrogenase gene (DPYD) polymorphism and DPD activity. Methods:The patients treated for GTD by fluoropyrimidines-containing regime were enrolled as the treatment group. The patients suffered from severe toxicity with fluoropyrimidines-containing treatment were informed for follow-up group. Blood samples were collected for determining DPD activity. The ratios of dihydrouracil/uracil (UH2/U),which can reflect the DPD activity,were determined by HPLC. DPYD genotype was identified beforehand,and the relationship between DPYD polymorphism and DPD activity was analyzed. Results:Among 130 patients,105 GTD patients were treated with fluoropyrimidines-containing regime,25 subjects were follow-up patients. UH2/U ratios in the treatment group and the follow-up group were (7.91±3.23) and (7.46±2.00),globally followed a Gaussian distribution,but a large degree of inter-individual variation was observed. The DPD activities of patients with the DPYD*2 or C2303A type mutation were lower than 70% of the mean DPD activity. It's suggested that the DPYD*2 and C2303A type mutation were associated with DPD activity deficiency. The mean UH2/U ratios in patients with DPYD*9 was lower than the mean DPD activity,but there was no significant difference. Conclusion:The DPYD*2 and C2303A type mutation which were associated with DPD activity deficiency were found in Chinese GTD patients,but the allelic frequencies of DPYD*2 and C2303A were lower than 1%. There was genetic polymorphism of DPYD*9,A720C and A2670C,but no correlation with DPD activity deficiency was observed.

1 病历摘要 患者,23岁,因葡萄胎清宫术后3月,双下肢乏力1月,排便困难15天,于2006年12月15日由外院转入我院.

OBJECTIVE:To investigate the effect of surgical resection in the management of gestational trophoblastic neoplasia (GTN) patients with pulmonary metastases.METHODS:A retrospective review of the medical records of 62 GTN patients who underwent pulmonary resection was carried out. The cases were divided into recurrent group (group A, n = 10), drug-resistant group (group B, n = 28), and the group with satisfactory response to chemotherapy but residual pulmonary lesion (s) (group C, n = 25). One patient underwent lobectomy twice, and she was allocated simultaneously to groups A and B. The patients' median age, antecedent pregnancy, International Federation of Gynecology and Obstetrics (FIGO) risk score, number of preoperative chemotherapy courses, preoperative beta-human chorionic gonadotrophin (beta-hCG) titer, lesion size, number of lobes affected, positive rate of histology, follow-ups and prognosis were compared between the three groups.RESULTS:The proportion of high-risk patients in the three groups was 90%, 82% and 44%, respectively. The complete remission rates of the three groups were 90%, 79% and 100%, with relapse rates of 2/8, 15% and zero, respectively. Positive histology of the resected specimen was more frequently recognized in recurrent and drug-resistant groups (A 60%, B 36%, C 12%). In the drug-resistant group there were more preoperative chemotherapy sessions (A 3, B 7, C 5) and more patients with abnormal preoperative beta-hCG titer (A 50%, B 61%, C 12%).CONCLUSIONS:Surgical resection is effective in the treatment of pulmonary metastases of GTN. Surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug-resistance and the lesions are relatively localized. Surgical resection is not recommended for patients with satisfactory response to chemotherapy but residual pulmonary lesions.

OBJECTIVE:To evaluate the efficacy of surgical management combined with chemotherapy in the treatment of drug-resistant gestational trophoblastic neoplasm (GTN) patients, and investigate factors influencing the outcome of the surgery combined with chemotherapy.METHODS:Medical records of 42 patents with drug-resistant GTN who were treated by chemotherapy combined with surgical management at Peking Union Medical College Hospital from Jan 1996 to Jan 2006 were reviewed.RESULTS:Among 42 patients, 32 achieved serologically complete remission (SCR) with an SCR rate of 76%, and 10 patients had a treatment failure. Treatment failure was more frequently seen in patients who also had metastasis of other sites except for lungs and vagina and patients with antecedent non-molar pregnancy (P = 0.023 and 0.017, respectively). Preoperative human chorionic gonadotropin-beta subunit (beta-hCG) titer > 10 U/L (P = 0.020), failure to reach normal serum titers of beta-hCG during treatment (P = 0.003), age > or = 35 years (OR: 12.6, 95% CI: 2.4 - 66.0, P = 0.002) and preoperative chemotherapy regimens > or = 4 (OR: 4.5, 95% CI: 1.0 - 20.1, P = 0.059) were also correlated with treatment failure. All the 10 patients with treatment failure had at least 3 of 6 above mentioned predictors of treatment failure.CONCLUSIONS:Surgical management combined with chemotherapy is effective in the treatment of drug-resistant GTN. Age > or = 35 years, antecedent non-molar pregnancy, metastasis of other sites except for lungs and vagina, preoperative beta-hCG titer > 10 U/L, failure to reach normal serum titers of beta-hCG during treatment, and preoperative chemotherapy regimens > or = 4 are significant predictors of treatment failure. Patients with 3 or more predictors of treatment failure usually have poor prognosis. Therefore, surgical management should not be performed for these patients.

OBJECTIVE:To analyze retrospectively the management and prognosis of malignant gestational trophoblastic neoplasia (GTN) patients treated at Peking Union Medical College (PUMC) Hospital from 1985 to 2005.STUDY DESIGN:From 1985 to 2005 1,130 GTN patients were treated at PUMC Hospital. Management and prognosis were analyzed retrospectively. The analyses of prognostic factors were performed by using univariate and multivariate analyses.RESULTS:Among the 1,130 patients 903 (80.0%) achieved complete remission (CR), 187 (16.5%) partial remission (PR) and 40 (3.5%) died of progress of the disease (PD). Among the CR patients, 31 (3.4%) relapsed later. Of the 187 PR patients, 155 (82.0%) had normal beta-hCG titer but with residual tumor in the lung or other organs. Among them, 6 patients with choriocarcinoma experienced PD after treatment. One hundred thirty-nine patients became pregnant during follow-up, with a total of 159 pregnancies. Among them, abnormal pregnancy rate was 16.4%, molar rate was 3.1% and fetal abnormality rate was 1.6%.CONCLUSION:Most GTN patients can be cured completely with timely and appropriate chemotherapy treatment. In select cases, surgery should be performed to obtain a better curative outcome. Patients whose residual metastatic tumors remain unchanged after beta-hCG returns to normal are assumed to have CR. We recommend that patients postpone pregnancy for at least 12 months after chemotherapy.

OBJECTIVE:To investigate the changes of the clinical features of hydatidiform mole.STUDY DESIGN:A total of 113 cases of hydatidiform mole treated in Peking Union Medical College Hospital during 1989-2006 were reviewed retrospectively, and a comparison was made to historic data from 1948-1975 using the chi2 test.RESULTS:The median age was 28 years (range, 20-55). The median gestational age was 90.2 days. Vaginal bleeding remains the most common presenting symptom, occurring in 94 of 113 cases (83.2%). Of 113 cases, 52 (46%) presented with excessive uterine size. Preeclampsia, hyperemesis, hemoptysis and theca lutein cysts occurred in 4 of 113 (3.5%), 12 of 113 (10.6%), 4 of 113 (3.5%) and 19 of 113 cases (16.8%), respectively. The incidence of postmolar trophoblastic neoplasia was 21% (24 of 113). Compared to historic data, the incidence of vaginal bleeding and preeclampsia were statistically lower (p < 0.005). The incidence of postmolar gestational trophoblastic neoplasia was increased moderately without statistical significance compared to historic data.CONCLUSION:Because of the wide use of ultrasonography and serum human chorionic gonadotropin test, current patients with hydatidiform mole have been diagnosed earlier in gestation and the clinical features have changed. Patterns of medical practice should be changed as well.

OBJECTIVE:To determine the efficacy of hysteroscopy and laparoscopy in differential diagnosis of pregnancy-related diseases, including gestational trophoblastic neoplasia (GTN), incomplete abortion and ectopic pregnancy.METHODS:Twenty-seven patients with a suspected diagnosis of GTN were transferred to Peking Union Medical College Hospital from September 2003 to March 2006, and underwent hysteroscopy and laparoscopy. Clinical data of patients were reviewed retrospectively. Most patients had abnormal vaginal bleeding and persistently elevated plasma beta human chorionic gonadotropin (beta-hCG) level for a median (53 +/- 37) days (range, 15 - 125 days) after evacuation. Ultrasound revealed a lesion with affluent blood flow in intrauterine, unilateral horn of uterus, or myometrium. No positive findings were revealed by computerized tomography or X-ray of the chest in all patients. Eleven patients underwent evacuation under hysteroscope, 10 patients were diagnosed and treated by laparoscopy, and 6 by hysteroscopy and laparoscopy.RESULTS:Choriocarcinoma was diagnosed in 4 patients, who achieved complete remission by chemotherapy later. The diagnosis of GTN was ruled out in the other 23 patients, including cornual pregnancy in 12, pregnancy in rudimentary horn in 1, and incomplete abortion in 10, who were cured by hysteroscopic and laparoscopic surgery and postoperative adjuvant single dose methotrexate.CONCLUSIONS:The major causes of pregnancy-related abnormal bleeding include incomplete abortion, ectopic pregnancy, and GTN. Hysteroscopy and laparoscopy are effective alternative of diagnosis for differentiation of GTN from non-GTN and can also offer therapeutic treatment.

OBJECTIVE To analyze retrospectively the prognosis of gestational trophoblastic neoplasia (GTN) patients who achieved normal human chorionic gonadotropin-beta subunit (beta-hCG) titer after completing treatment but remained with residual lung tumor. METHODS A total of 1130 GTN patients were hospitalized at Peking Union Medical College Hospital from Jan 1985 to Jan 2004. Among these patients, 901 achieved complete remission (CR); 152 achieved normal blood beta-hCG titer after the completion of treatment but remained with residual lung tumor (defined as partial remission). Retrospective analyses were carried out on the 152 patients. Statistical analysis was used to compare the recurrent rate of the CR patients with the progression rate of the 152 patients. RESULTS The blood beta-hCG level of all the 152 patients returned to normal after they received 1-30 courses of standard multiple-drug combined chemotherapy treatment. Another 0-8 courses of chemotherapy were applied to these patients before they left hospital. Seventeen of the 152 patients lost to follow-up. Of the rest 135 patients followed up for 14 to 110 months, 83 showed no significant changes in terms of their residual tumors; the residual tumors in 46 patients diminished or disappeared; and the other 6 patients had progression of disease (PD), with beta-hCG levels going up 6-8 months after completing treatment (increased lung metastases were observed in four of the six patients). There was no significant difference (P > 0.05) between the recurrent rate [3.4% (31/901)] of the 901 CR patients and the progression rate [3.9% (6/152)] of the 152 patients. There was also no significant difference (P > 0.05) between the recurrent rate [2.2% (10/463)] of the CR patients with lung metastasis and the progression rate of the 152 patients. CONCLUSIONS After normalization of beta-hCG titer, patients whose lung tumors remained unchanged even after several additional courses of chemotherapy should be considered as CR patients. Follow-ups should be strictly carried out on these patients, especially at around 6 months after the completion of treatment, and particularly for high-risk and drug-resistant choriocarcinoma patients.

Objective:To investigate the changes of the clinical features of hydatidiform mole.Methods: One hundred and thirteen cases of hydatidiform mole treated in Peking Union Medical College Hospital during 1989-2006 were studied retrospectively and a comparison was made to historic data(1948-1975) using χ2 test.Results: The median age was 28 years(ranges from 20 to 55 years).The median gestational age was 90.2 days.Vaginal bleeding remained the most common presenting symptom,occurring in 94 of 113 cases(83.2%).Fifty-two of 113 cases(46%) presented with excessive uterine size.Pregnancy induced hypertension symdrome(PIH),hyperemesis,hemoptysis and theca lutein cysts occurred in 4(3.5%),12(10.6%),4(3.5%) and 19 of 113 cases(16.8%) respectively.Incidence of postmolar trophoblastic neoplasia was 21%(24 of 113).Compared to the historic data,the incidence of vaginal bleeding and PIH were statistically lower(P0.005),while the incidence of postmolar gestation trophoblastic neoplasia(GTN) was increased moderately without statistical significance.Conclusions: Because of the wide use of ultrasonography and serum hCG test,the patients with hydatidiform mole have been diagnosed earlier in gestation and the clinical features have changed.Patterns of medical practice should be changed accordingly.

Objective. To analyze retrospectively the prognosis of gestational trophoblastic neoplasia (GTN) patients who achieved normal beta-hCG titer after completing treatment but remained with residual lung tumor.Method. A total of 1130 GTN patients were hospitalized at Peking Union Medical College Hospital from January 1985 to January 2004. Among these patients, 901 achieved complete remission (CR); 152 achieved normal blood beta-hCG titer after the completion of treatment but remained with residual lung tumor (defined as partial remission). Retrospective analyses were carried out on the 152 patients. Statistical analysis was used to compare the recurrent rate of the CR patients with the progression rate of the 152 patients.Result. 17 of the 152 patients lost follow-up. Of the rest 135 patients followed up from 14 to 110 months, 83 showed no significant changes as to their residual tumors; 46 patients' residual tumors diminished or disappeared; and the other 6 patients got progression of disease (PD), with beta-hCG level going up 6-8 months after completing treatment. There is no significant statistical difference (P > 0.05) between the recurrent rate of the 901 CR patients and the progression rate of the 152 patients. There is also no significant statistical difference (P > 0.05) between the recurrent rate of the CR patients with lung metastasis and the progression rate of the 152 patients.Conclusion. After achieving normal beta-hCG titer, patients whose lung tumor stayed unchanged even following several additional courses of chemotherapy should be considered as CR patients. Follow-ups should be strictly carried out on these patients, especially at around 6 months after the completion of treatment, and particularly for high-risk and drug-resistant choriocarcinoma (CC) patients. (c) 2006 Elsevier Inc. All rights reserved.

Objective To evaluate characteristics,treatment and clinical prognosis of gestational trophoblastic neoplasia patients with urinary system metastasis.Methods We retrospectively analyzed 19 GTN patients with urinary system metastasis treated in our hospital during 1987-2005.All patients received 5-FU combined chemotherapy or EMA/CO regimen,and 5 of them were treated with 5-FU bladder perfusion.Selective arterial embolization had been performed to control severe hemorrhage in 7 patients.Intrathecal MTX chemotherapy was utilized for 5 patients with intracranial metastases.Results After 2~22 courses of chemotherapy,among 19 patients,11 had achieved complete remission;biochemical remission was obtained in 2 patients who were alive with residual tumor;4 patients with brain metastases died;the other 2 patients developed drug resistance and their conditions grew worse,then they gave up treatment and left our hospital.The survival rate was 68%.Conclusion The curative effect of standard systemic and local chemotherapy for GTN patients with urinary metastasis is appreciated.The prognosis of the patients complicated with bladder metastasis is better than those complicated with kidney metastasis.Gestational trophoblastic neoplasia cells are transferred to kidney mainly by blood circulation.Selective arterial embolization can be selected as primary alternative for victims of severe hemorrhage of bladder or vagina metastasis.