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

Abstract

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.

Results with Floxuridine, Actinomycin D, Etoposide, and Vincristine in Gestational Trophoblastic Neoplasias with International Federation of Gynecology and Obstetrics Scores ≥5

“…As such, patients who are resistant to FAEV still have the option of switching to EMA/CO. Six of our patients (2.9%) relapsed after completing treatment; this was consistent with the relapse rate of 2.7% in our previous study of 1,250 patients with GTN who received primary treatment at our center [25] and lower than that of patients treated with EMA/CO (3% to 16.4%) [7,10,[12][13][14]. Further clinical trials should be performed to compare FAEV with EMA/CO.…”

Evaluation the Recurrence Risk of Gestational Trophoblastic Neoplasia (GTN) after Serum βhCG Normalization

“…In the Yang study, in contrast to the present study, the median duration of recurrence was reported, whereas, in our study, the meantime was reported. Besides, similar to the present study in the Yang study, it was shown that more than 78% of patients had recurrence within one year after treatment, and 10% had recurrence after two years (Kong, Zong, Cheng, Jiang, Wan, Feng, Ren, Zhao, Yang, & Xiang, 2020). These findings indicate the need for long term monitoring of bHcg levels after complete recovery.…”

“…Yang et al In a study of 1130, patients have reported the 314 patients with recurrent GTN (3.4%), which was similar to the results obtained in this study (Yang, Xiang, Wan, & Yang, 2006). However, another study by the same group found a 6.5% recurrence GTN rate between, which was much more than our study findings (Kong, Zong, Cheng, Jiang, Wan, Feng, Ren, Zhao, Yang, & Xiang, 2020). Also, Barga et al, In a study on GTN, followed molar pregnancy, showed that 10 of 2284 GTN patients would relapse (Braga, Maestá, Matos, Elias, Rizzo, & Viggiano, 2015).…”

“…Given that high-risk patients are being treated with multi-drug chemotherapy regimens, the higher incidence of recurrence in these patients may have been due to high-risk GTN. A study by Yang and colleagues also showed that the recurrence rate in high-risk patients was 6.9% and approximately four times higher than the low-risk patients (Kong, Zong, Cheng, Jiang, Wan, Feng, Ren, Zhao, Yang, & Xiang, 2020). Couder and colleagues also found that patients who required more than four doses of MTX to normalize bhCG levels had a significantly higher recurrence risk (Couder, Massardier, You, Abbas, Hajri, Lotz, Schott, & Golfier, 2016).…”

Identification and treatment of primary cervical gestational trophoblastic neoplasia: a retrospective study of 13 patients and literature review

“…In all, 23 patients with cervical GTN underwent a prognostic analysis, among whom three relapsed 4-6 months after their last chemotherapy session. The recurrence rate was 13%, which was higher than that in a review of 1827 patients with GTN who achieved CR at our center, 118 (6.5%) of whom experienced recurrence during follow-up [27]. Notably, two of the three patients who relapsed in the study had not undergone hysterectomy, with the site of recurrence being the cervix.…”