Clinical characteristics and outcomes of choriocarcinoma in postmenopausal women

Abstract

Objective : Choriocarcinoma is a highly malignant epithelial tumor and primarily occurs in women of childbearing age, while it is extremely rare in postmenopausal women and only scattered cases have been reported worldwide. In addition, whether the prognosis scoring system for gestational trophoblastic neoplasm is suitable for postmenopausal women is still controversial and there is no consistent strategy for the treatment and management. Therefore, the aim of this study is to summarize and analyze the clinicopathologic features of choriocarcinoma in postmenopausal women to increase the awareness of this rare disease.Method : We retrieved the PubMed, Web of science, Embase, and CBM databases to search relevant published literatures, and then, the details of each patient's clinical and pathological characteristics were extracted and analyzed. Univariate log-rank tests were used to examine the association between clinicopathologic characteristics and progression-free survival (PFS) and overall survival(OS).Results : 33 patients, according to the given inclusion and exclusion criteria, were included in this study. The patients originated from different continents, with 55% located in Asia and 27% in North America.The mean age of these patients was 59 years (range 48-74years) and the mean age at menopause was 49.7 years (from 39 to 57 years). The median interval from antecedent pregnancy to diagnosis was 22 years(5-42years). The mean time of the duration of menopause of patients recorded relevant information was 9 years(1-26years).The mean β-HCG titer was 235,644 mIU/mL. 22 patients presented with abnormal vaginal bleeding, 4 with lesion-related pain. The site of primary lesions distribution relatively broad, mainly in uterus and lung. 29 patients were classified as high-risk disease. 22 patients underwent curative surgery with or without chemotherapy, 11 patients received only chemotherapy, and most chemotherapy regimens were EMA-CO.Stage of disease was significantly associated with both PFS and OS (P=0.007;P=0.040).The median follow-up time was 21 months, with 2 cases recurred, 2 progressed, and 5 died. The tumor were positive for HCG, CK, HPL,PLAP and EMA.Conclusion : We observed that abnormal vaginal bleeding and lesion-related pain are the most common presenting features of postmenopausal choriocarcinoma. The patients often have metastatic lesions, high level serum β-HCG, and classified to high-risk disease when diagnosed. Moreover, the prognosis in those patients are worse than those in reproductive period. As in patients with choriocarcinoma of childbearing age, stage is still the main prognostic factor.