Inadequate Medical Intervention (IMI) as a Prognostic Factor in High Risk Gestational Trophoblastic Neoplasia (HRGTN) Patients

Bianconi, María Inés; Otero, S.; Moscheni, Oriana; Álvarez, Lainys María Rojas; Storino, Claudio; Jankilevich, Gustavo

doi:10.1016/s0923-7534(20)33563-8

Cited by 2 publications

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“…Such unfavorable sociodemographic status has also been reported by other centers in developing countries. 2 14 15 16 17…”

Section: Discussionmentioning

confidence: 99%

Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease

Silva,

Maestá,

Costa

et al. 2023

Rev Bras Ginecol Obstet

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Objective To assess the potential relationship of clinical status upon admission and distance traveled from geographical health district in women with gestational trophoblastic disease (GTD). Methods This is a cross-sectional study including women with GTD from the 17 health districts from the São Paulo state (I–XVII), Brazil, referred to the Botucatu Trophoblastic Disease Center (specialized center, district VI), between 1990 and 2018. At admission, hydatidiform mole was assessed according to the risk score system of Berkowitz et al. Gestational trophoblastic neoplasia was evaluated using the International Federation of Gynecology and Obstetrics / World Health Organization (FIGO/WHO) staging/risk score. Data on demographics, clinical status and distance traveled were collected. Multiple regression analyses were performed. Results This study included 366 women (335 hydatidiform mole, 31 gestational trophoblastic neoplasia). The clinical status at admission and distance traveled significantly differed between the specialized center district and other districts. Patients referred from health districts IX (β = 2.38 [0.87–3.88], p = 0.002) and XVI (β = 0.78 [0.02–1.55], p = 0.045) had higher hydatidiform mole scores than those from the specialized center district. Gestational trophoblastic neoplasia patients from district XVI showed a 3.32 increase in FIGO risk scores compared with those from the specialized center area (β = 3.32, 95% CI = 0.78–5.87, p = 0.010). Distance traveled by patients from districts IX (200km) and XVI (203.5km) was significantly longer than that traveled by patients from the specialized center district (76km). Conclusion Patients from health districts outside the specialized center area had higher risk scores for both hydatidiform mole and gestational trophoblastic neoplasia at admission. Long distances (>80 km) seemed to adversely influence gestational trophoblastic disease clinical status at admission, indicating barriers to accessing specialized centers.

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“…Such unfavorable sociodemographic status has also been reported by other centers in developing countries. 2 14 15 16 17…”

Section: Discussionmentioning

confidence: 99%

Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease

Silva,

Maestá,

Costa

et al. 2023

Rev Bras Ginecol Obstet

View full text Add to dashboard Cite

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“…Second-line treatment consisted of switching the first single agent used (MTX as first-line switched for ActD as second line and vice versa) or capecitabine. 15 All patients either resistant to MTX or with MTX toxicity were eligible for ActD or capecitabine second-line therapy. Two patients received etoposide due to ActD unavailability, and three were given multiagent chemotherapy due to a higher FIGO score (score of 6) or hCG > 30,000 IU/L at the point of resistance to first-line single agent therapy.…”

Section: Methodsmentioning

confidence: 99%

“…There are few studies on GTN treatment response in South American patients, 15 16 17 18 and most of them are single-center, hospital-based. 19 The difficulties in carrying out multicentric studies in South American countries include socioeconomic and cultural diversities, as well as language barriers (Portuguese, Spanish, English).…”

Section: Introductionmentioning

confidence: 99%

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

Ramírez

Maestá

Bianconi

et al. 2022

Rev Bras Ginecol Obstet

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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.

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Inadequate Medical Intervention (IMI) as a Prognostic Factor in High Risk Gestational Trophoblastic Neoplasia (HRGTN) Patients

Cited by 2 publications

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Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease

Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease

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

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