Clinical parameters predicting therapeutic response to surgical management in patients with chemotherapy-resistant gestational trophoblastic neoplasia

Abstract

Objective Several studies have reported that surgical management of chemotherapy-resistant gestational trophoblastic neoplasia (GTN) is a useful adjunct to chemotherapy. We investigated the pretreatment predictive factors of therapeutic response in response to surgical management combined with chemotherapy. Methods The study involved 61 patients with chemotherapy-resistant GTN who underwent surgery between January 1996 and January 2007. Responses to the combination therapy with surgery and chemotherapy were assessed after the end of treatment. Statistical analyses were performed to identify preoperative clinical factors associated with response of chemotherapy-resistant GTN. Results After the end of combination therapy, 47 (77.0%), 4 (6.6%), 1 (1.6%), and 9 (14.8%) of 61 patients showed complete response (CR), partial remission (PR), stable disease (SD), and progressive disease (PD), respectively. Univariate analysis found that predictors of response were age ( p = 0.022), antecedent pregnancy ( p = 0.022), site of metastasis ( p = 0.026), and preoperative serum human chorionic gonadotropin-beta subunit (β-hCG) level ( p = 0.027). All patients with treatment failure had 2 or more of unfavorable factors, including age older than 35 years, antecedent non-molar pregnancy, distant metastasis outside of lungs and uterus, and preoperative serum β-hCG level greater than 10 IU/L. Conclusions The data suggest that age older than 35 years, antecedent non-molar pregnancy, distant metastasis outside of lungs and uterus, and a preoperative serum β-hCG level greater than 10 IU/L are important clinical predictors of treatment failure to surgery. They may benefit in the selection of salvage surgery as well as the assessment of individual prognosis.