Abstract
Background: Gestational trophoblastic neoplasia (GTN) can derive either from molar or non-molar pregnancy. Our primary objective is to compare clinical presentation and outcome of treatment of non-molar and post-molar GTN. Our secondary outcome is to evaluate and compare the prognostic factors of non-molar GTN compare to post-molar GTN in subgroup classification of GTN patients by stage and by low-risk and high-risk groups.Methods: Retrospective chart review of GTN patients treated from 2007 to 2016 was done. General characteristics, clinical data, treatment options and treatment outcomes were collected. The cases with missing significant data were excluded. Statistics analysis of the data was performed with SPSS version 22.0. Mean, mode, median and percent were used to present the data. Student t-test, Mann Whitney-U test and Kaplan Meier were used to analyze the data. The results were presented in Tables or graphs where appropriate. Results: Total of 71 GTN patients were recruited into the study. Fifty-one patients were post-molar GTN and 20 were non-molar GTN patients. The mean age of the patients was not different (p=0.25). Median duration from previous pregnancy and time to achieve remission were longer in non-molar GTN (292 days vs. 42 days and 163 vs. 64 days, respectively). Mortality rate of the non-molar GTN is higher that of the post-molar GTN (15% vs. 1.9%). Comparison of stage to stage showed no differences between the post-molar and the non-molar GTN. According to previous pregnancy type, post-abortion had higher resistant to treatment rate than post-term delivery.Conclusion: Non-molar GTN is different form post-molar GTN in several aspects, such as the duration from previous pregnancy, stage and score at diagnosis, treatment resistance and mortality rate. Comparison between the non-molar and post-molar GTN stage by stage and risk scores could not identify the difference between the two groups.
Highlights
Gestational trophoblastic disease (GTD) is a group of diseases which comprises both benign and malignant disorders [1]
From the result of our study, non-molar Gestational trophoblastic neoplasia (GTN) had long time to achieve remission and higher mortality rate compared to post-molar GTN
Most of post-molar GTN had no symptom at the diagnosis and the diagnosis depended on hCG criteria which was different from non-molar GTN
Summary
Gestational trophoblastic disease (GTD) is a group of diseases which comprises both benign and malignant disorders [1]. Non-molar GTN patients usually present at late stage and high score. Other poor prognostic factors for GTN are stage of the disease, duration from previous pregnancy, pretreatment β-hCG level, history of failure of treatment with chemotherapy and liver metastasis [10,11,12]. When considering those risk factors, many factors are overlapped in clinical presentation of non-molar GTN. Our secondary outcome is to evaluate and compare non-molar GTN compare to post-molar GTN as subgroup classification of GTN patient by stage and by low-risk and high-risk groups
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