Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America
- 1 September 2020
- journal article
- research article
- Published by BMJ in International Journal of Gynecologic Cancer
- Vol. 30 (9), 1366-1371
- https://doi.org/10.1136/ijgc-2020-001237
Abstract
Background South America has a higher incidence of gestational trophoblastic disease than North America or Europe, but whether this impacts chemotherapy outcomes is unclear. The purpose of this study was to evaluate outcomes among women with high-risk gestational trophoblastic neoplasia (GTN) treated at trophoblastic disease centers in developing South American countries. Methods This retrospective cohort study included patients with high-risk GTN treated in three trophoblastic disease centers in South America (Botucatu and Rio de Janeiro, Brazil, and Buenos Aires, Argentina) from January 1990 to December 2014. Data evaluated included demographics, clinical presentation, FIGO stage, WHO prognostic risk score, and treatment-related information. The primary treatment outcome was complete sustained remission by 18 months following completion of therapy or death. Results Among 1264 patients with GTN, 191 (15.1%) patients had high-risk GTN and 147 were eligible for the study. Complete sustained remission was ultimately achieved in 87.1% of cases overall, including 68.4% of ultra high-risk GTN (score >= 12). Early death (within 4 weeks of initiating therapy) was significantly associated with ultra high-risk GTN, occurring in 13.8% of these patients (p=0.003). By Cox's proportional hazards regression, factors most strongly related to death were non-molar antecedent pregnancy (RR 4.35, 95% CI 1.71 to 11.05), presence of liver, brain, or kidney metastases (RR 4.99, 95% CI 1.96 to 12.71), FIGO stage (RR 3.14, 95% CI 1.52 to 6.53), and an ultra-high-risk prognostic risk score (RR 7.86, 95% CI 2.99 to 20.71). Median follow-up after completion of chemotherapy was 4 years. Among patients followed to that timepoint, the probability of survival was 90% for patients with high-risk GTN (score 7-11) and 60% for patients with ultra-high-risk GTN (score >= 12). Conclusion Trophoblastic disease centers in developing South American countries have achieved high remission rates in high-risk GTN, but early deaths remain an important problem, particularly in ultra-high-risk GTN.This publication has 25 references indexed in Scilit:
- Analysis of the Prognosis and Related Factors for Patients With Stage IV Gestational Trophoblastic NeoplasiaInternational Journal of Gynecologic Cancer, 2014
- Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upAnnals of Oncology, 2013
- Prognostic factors associated with time to hCG remission in patients with low-risk postmolar gestational trophoblastic neoplasiaGynecologic Oncology, 2013
- EMA/CO for High-Risk Gestational Trophoblastic Neoplasia: Good Outcomes With Induction Low-Dose Etoposide-Cisplatin and Genetic AnalysisJournal of Clinical Oncology, 2013
- Current advances in the management of gestational trophoblastic diseaseGynecologic Oncology, 2013
- Fatal cases of gestational trophoblastic neoplasia over four decades in the Netherlands: a retrospective cohort studyBJOG: An International Journal of Obstetrics and Gynaecology, 2012
- Importance of salvage therapy in the management of high-risk gestational trophoblastic neoplasia (GTN)Gynecologic Oncology, 2012
- Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasiaAmerican Journal of Obstetrics and Gynecology, 2011
- Gestational trophoblastic diseaseThe Lancet, 2010
- FIGO staging for gestational trophoblastic neoplasia 2000International Journal of Gynecology & Obstetrics, 2002