Clinical characteristics and prognosis of ultra high-risk gestational trophoblastic neoplasia patients: A retrospective cohort study

Kong, Yujia; Yang, Junjun; Jiang, Fang; Zhao, Jun; Ren, Tong; Li, Jie; Wang, Xiaoyu; Feng, Fengzhi; Wan, Xirun; Xiang, Yang

doi:10.1016/j.ygyno.2017.04.010

Cited by 37 publications

(39 citation statements)

References 20 publications

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“…Floxuridine-based combination chemotherapy (FAEV) has been favored for the management of high-risk GTN patients for the past 3 decades in People’s Republic of China. 2 , 11 , 13 Single-agent mercaptopurine or chlormethine was the regimen of choice for GTN patients between1945 and 1965, before the introduction of FAEV. 9 Data from the Charing Cross Hospital suggest that the overall survival rate of patients with liver metastases improved from 27% to 48%, owing to the introduction of EMA-CO and EP/EMA during the past 3 decades.…”

Section: Discussionmentioning

confidence: 99%

“…Both brain and liver metastases were found to be poor prognostic factors in GTN patients in our previous studies, with 5-year overall survival rates of 71.1% and 55.7%, respectively. 2 , 4 , 11 Barber et al 6 revealed that concomitant brain metastasis predicted shorter survival in patients with liver metastasis, although only 17 patients were included in their analysis. While brain metastasis was not associated with reduced survival according to the univariate and multivariate analyses, 41.7% of the patients (n = 5) died of the disease, which is a noteworthy statistic.…”

Section: Discussionmentioning

confidence: 99%

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Management and prognosis of patients with liver metastases from gestational trophoblastic neoplasia: a retrospective cohort study

Zong

Yang

Wang

et al. 2018

CMAR

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PurposeThe aims of this study were to analyze the clinical features, identify prognostic factors, and evaluate the survival outcomes of gestational trophoblastic neoplasia (GTN) patients with liver metastases.Patients and methodsForty patients with liver metastases arising from GTNs, who were treated at the Peking Union Medical College Hospital (Beijing, People’s Republic of China) between January 1999 and December 2015, were recruited from the institutional database, and their medical records were reviewed. Univariate and multivariate analyses were performed to identify independent risk factors for survival.ResultsTwenty-seven patients (67.5%) achieved complete remission after multidrug chemotherapy treatment. The remaining 13 patients (32.5%) had disease progression. Eighteen patients (45.0%) died during treatment or follow-up. A history of failed multidrug chemotherapy was an independent risk factor for survival (OR: 5.57, 95% CI: 1.42–21.86, P=0.014). Moreover, patients with an International Federation of Gynecology and Obstetrics (FIGO) score of >16 had a significantly poorer survival than those with a score of ≤16 (P<0.001).ConclusionGTN with liver metastasis is a very rare disease with a relatively poor prognosis. Patients with a history of failed multidrug chemotherapy and a FIGO score of >16 have poorer survival outcomes. Multidrug chemotherapy is the key to the management of GTN patients with liver metastases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Management and prognosis of patients with liver metastases from gestational trophoblastic neoplasia: a retrospective cohort study

Zong

Yang

Wang

et al. 2018

CMAR

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“…A number of factors should be considered when planning treatment for recurrent GTN, most notably the prerecurrence chemotherapy and the site of the recurrent tumor. Several salvage multiagent chemotherapy regimens were used at our center; the most common regimen was FAEV, the details of which were described previously . FAEV was administered to patients who had good responses to floxuridine‐based multiagent chemotherapies at initial treatment or to patients who had not previously been treated with this chemotherapy regimen.…”

Section: Methodsmentioning

confidence: 99%

Management and risk factors of recurrent gestational trophoblastic neoplasia: An update from 2004 to 2017

et al. 2020

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Objective We investigated the clinical characteristics, treatments, and survival of patients with gestational trophoblastic neoplasia (GTN) who experienced recurrence. Factors predictive of recurrence were also investigated. Methods Patients with GTN who recurred after completing chemotherapy at Peking Union Medical College Hospital Trophoblastic Disease Center were identified between January 2004 and December 2017. Logistic regression analysis was used to identify factors predictive of GTN recurrence. Results A total of 1827 patients with GTN achieved complete remission (CR) at our center, of whom 118 (6.5%) experienced recurrence during follow‐up. The recurrence rates for patients initially treated at our center and those referred to us were 2.7% and 14.6%, respectively. The majority of recurrent patients received floxuridine‐based multiagent chemotherapy (n = 64). Patients who underwent surgery achieved a significantly higher CR rate than those who did not (88.6% vs 61.1%, P = .001). Although 94.1% of recurrent patients reachieved CR, 33.3% of them recurred for a second time. The 5‐year survival rate of the entire cohort was 80.4%. An interval between antecedent pregnancy and chemotherapy >12 months (OR: 6.600, 95% CI [3.217‐13.540], P < .001), and an interval from first chemotherapy to achieving β‐human chorionic gonadotropin (β‐hCG) normalization >14 weeks (OR: 2.226, 95% CI [1.080‐4.588], P = .030) were predictors of recurrence. Conclusions Patients with recurrent GTN are prone to recurring for a second time. Surgery plays a beneficial role in the management of recurrent GTN. An interval between antecedent pregnancy and chemotherapy >12 months, and an interval from first chemotherapy to achieving β‐hCG normalization >14 weeks were predictors of recurrence.

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“…4,67 Induction Chemotherapy for Ultra-High-Risk Disease Patients with widespread metastatic GTN, as evidenced by a prognostic score .12, have a poorer prognosis. 73,74 Initiation of standard combination chemotherapy in these patients can lead to tumor collapse with hemorrhage, metabolic acidosis, septicemia, and/or multiple organ failure, resulting in the potential for early death (ie, within 4 weeks). 18,52,74 Efforts to improve outcomes for this ultra-high-risk population have included induction chemotherapy with etoposide and cisplatin before starting EMA/CO.…”

Section: High-risk Gtnmentioning

confidence: 99%

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

Abu‐Rustum

Yashar

Bean

et al. 2019

Journal of the National Comprehensive Cancer Network

105

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Gestational trophoblastic neoplasia (GTN), a subset of gestational trophoblastic disease (GTD), occurs when tumors develop in the cells that would normally form the placenta during pregnancy. The NCCN Guidelines for Gestational Trophoblastic Neoplasia provides treatment recommendations for various types of GTD including hydatidiform mole, persistent post-molar GTN, low-risk GTN, high-risk GTN, and intermediate trophoblastic tumor.

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Clinical characteristics and prognosis of ultra high-risk gestational trophoblastic neoplasia patients: A retrospective cohort study

Cited by 37 publications

References 20 publications

Management and prognosis of patients with liver metastases from gestational trophoblastic neoplasia: a retrospective cohort study

Management and prognosis of patients with liver metastases from gestational trophoblastic neoplasia: a retrospective cohort study

Management and risk factors of recurrent gestational trophoblastic neoplasia: An update from 2004 to 2017

Gestational Trophoblastic Neoplasia, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

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