Clinical Presentation, Treatment Outcomes, and Resistance-related Factors in South American Women with Low-risk Postmolar Gestational Trophoblastic Neoplasia

Abstract

Objective There are few multinational studies on gestational trophoblastic neoplasia (GTN) treatment outcomes in South America. The purpose of this study was to assess the clinical presentation, treatment outcomes, and factors associated with chemoresistance in low-risk postmolar GTN treated with first-line single-agent chemotherapy in three South American centers. Methods Multicentric, historical cohort study including women with International Federation of Gynecology and Obstetrics (FIGO)-staged low-risk postmolar GTN attending centers in Argentina, Brazil, and Colombia between 1990 and 2014. Data were obtained on patient characteristics, disease presentation, and treatment response. Logistic regression was used to assess the relationship between clinical factors and resistance to first-line single-agent treatment. A multivariate analysis of the clinical factors significant in univariate analysis was performed. Results A total of 163 women with low-risk GTN were included in the analysis. The overall rate of complete response to first-line chemotherapy was 80% (130/163). The rates of complete response to methotrexate or actinomycin-D as first-line treatment, and actinomycin-D as second-line treatment postmethotrexate failure were 79% (125/157), 83% (⅚), and 70% (23/33), respectively. Switching to second-line treatment due to chemoresistance occurred in 20.2% of cases (33/163). The multivariate analysis demonstrated that patients with a 5 to 6 FIGO risk score were 4.2-fold more likely to develop resistance to first-line single-agent treatment (p = 0.019). Conclusion 1) At presentation, most women showed clinical characteristics favorable to a good outcome, 2) the overall rate of sustained complete remission after first-line single-agent treatment was comparable to that observed in developed countries, 3) a FIGO risk score of 5 or 6 is associated with development of resistance to first-line single-agent chemotherapy.

Fatores de risco e prognóstico em neoplasia trofoblástica gestacional: Uma revisão

“…No que se refere a relação da mola hidatiforme e a NTG, tem-se que a mola hidatiforme é considerada uma lesão prémaligna, e uma porcentagem de casos de mola hidatiforme pode progredir para a forma maligna da doença, como o coriocarcinoma. Entre 50 e 80% de todos os casos de NTG se originam de uma mola hidatiforme e o restante de uma gravidez a termo/pré-termo, aborto espontâneo ou gravidez ectópica (Ramírez et al 2022). Portanto, as mulheres que tiveram uma mola hidatiforme anterior têm um risco aumentado de desenvolver NTG, especialmente se a mola hidatiforme foi completa (envolvendo todos os tecidos da placenta) ou se houve complicações durante o tratamento.…”

“…Devido a essa associação, é essencial que mulheres com histórico de mola hidatiforme sejam acompanhadas de perto durante as gestações subsequentes e que sejam submetidas a exames de acompanhamento, como dosagens séricas de beta-hCG e ultrassonografias (Couder et al, 2016;Ramírez et al 2022).…”