Abstract
PurposeTo evaluate the oncological safety and pregnant outcomes of fertility-sparing uterine lesion resection in treating gestational trophoblastic neoplasias.ResultsAfter the treatment of surgery and chemotherapy, all the patients achieved complete remission. With a median follow-up time of 44 months (range, 6-188), 3 patients (3.85%) relapsed within 3-26 months. Multivariate analysis showed that tumor size was the independent risk factor of recurrence and the cutoff value was 4.2cm. Among 37 patients who attempted to conceive, 31 achieved clinical pregnancy. The rate of pregnancy and live birth were 83.8% and 77.4%. Uterine rupture did not occurred no matter in cesarean section or vaginal delivery. No congenital abnormalities were reported among the live births.MethodsFrom January 1995 to December 2014, 78 patients with gestational trophoblastic neoplasias who underwent fertility-sparing uterine lesion resection at Peking Union Medical College Hospital were reviewed. The complete remission rate, fertility rate, pregnant outcomes and risk factors of recurrence were analyzed.ConclusionsFertility-sparing uterine lesion resection might be considered as a safe and reasonable alternative for high-selected young women to remove uterine lesion in the treatment of gestational trophoblastic neoplasias.
Highlights
Gestational trophoblastic neoplasias (GTNs) used to describe a spectrum of diseases derived from trophoblasts and often occurred in young women of child-bearing age
The mean serum β-hCG level before treatment was 154873.2 IU/L. 43 patients (55.1%) were low-risk according to the International Federation of Gynecology and Obstetrics (FIGO) prognostic scoring system. 42 patients were diagnosed with stage I, 1 with stage II, 31 with stage III, and 4 with stage IV
The percentage of patients with metastases was 46.2% (36/78), which included 34 cases with lung metastases, 2 with liver metastases, 1 with vaginal metastasis, 1 with brain metastasis and 1 with pelvic wall metastasis. 8 patients had GTN history before and 10 patients were transferred to our hospital because resistant to multi-drug chemotherapy in local hospitals
Summary
After the treatment of surgery and chemotherapy, all the patients achieved complete remission. With a median follow-up time of 44 months (range, 6-188), 3 patients (3.85%) relapsed within 3-26 months. Multivariate analysis showed that tumor size was the independent risk factor of recurrence and the cutoff value was 4.2cm. Among 37 patients who attempted to conceive, 31 achieved clinical pregnancy. The rate of pregnancy and live birth were 83.8% and 77.4%. Uterine rupture did not occurred no matter in cesarean section or vaginal delivery. No congenital abnormalities were reported among the live births
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