Abstract
Background: Gestational trophoblastic neoplasia (GTN) with urinary system metastasis is rare. There is limited information about this situation. This study aimed to analyze clinical features, prognostic factors, and survival outcomes of patients with metastasis to the urinary system arising from GTN.Methods: Medical records of 53 consecutive GTN patients with urinary system metastases and treated at Peking Union Medical College Hospital (PUMCH) between 1990 and 2018 were reviewed. The Kaplan-Meier survival analysis was used to describe the overall survival. Prognostic factors were identified using univariate and multivariate analyses.Results: Fifty-three GTN patients with urinary tract metastasis were identified in our institution. The mean age of patients was 30.8 years (range, 23–53 years). Thirty-six (67.9%) patients achieved complete remission (CR), and the remaining 17 (32.1%) showed progressive disease. The 5-year overall survival rate of the entire cohort was 78.4%. Age ≥ 40 years was an independent risk factor for prognosis (HR 12.353, 95% CI 2.203-69.261, P = 0.004). Previous failed chemotherapy history (P = 0.040) and the presence of brain and/or liver metastases (P = 0.024) significantly influenced the survival of GTN patients with urinary tract system metastasis.Conclusion: GTN with urinary tract metastasis is a rare condition. Patients with different metastatic sites have different CR rates and prognosis. Therefore, individualized strategies should be considered for patients with different metastatic sites. Urinary system metastasis is probably not a prognostic factor in GTN patients. Patients aged ≥40, those who had previous failed multidrug chemotherapy, and presented brain and/or liver metastases showed a significant adverse outcome.
Highlights
Gestational trophoblastic neoplasia (GTN) arises from the abnormal proliferation of placental trophoblastic cells and comprises a malignant invasive mole, choriocarcinoma, placental site trophoblastic tumor, and an epithelioid trophoblastic tumor [1, 2]
Urinary system metastatic disease was diagnosed based on GTN history and lesions located in the kidneys, ureter, and bladder, which were found on ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI)
Between 1990 and 2018, 3,172 patients were diagnosed with GTN in total, of which 53 (1.67%) patients presented metastasis to the urinary system in the Peking Union Medical College Hospital (PUMCH)
Summary
Gestational trophoblastic neoplasia (GTN) arises from the abnormal proliferation of placental trophoblastic cells and comprises a malignant invasive mole, choriocarcinoma, placental site trophoblastic tumor, and an epithelioid trophoblastic tumor [1, 2]. The International Federation of Gynecology and Obstetrics (FIGO) scoring system was used to predict the prognosis of GTN patients. According to FIGO Cancer Report 2018, GTN patients were divided into a low-risk group (FIGO score < 7), high-risk group (7 ≤ FIGO score ≤ 12), and an ultra-high-risk subgroup (FIGO score > 12) [1]. GTN with urinary system metastasis is rare. Due to limited information about GTN with urinary system metastasis, we conducted a retrospective analysis to evaluate the clinical features, prognostic factors, and survival outcomes of GTN patients with urinary system metastasis. Gestational trophoblastic neoplasia (GTN) with urinary system metastasis is rare. This study aimed to analyze clinical features, prognostic factors, and survival outcomes of patients with metastasis to the urinary system arising from GTN
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