Management and prognostic analysis of patients with gestational trophoblastic neoplasia (GTN) in FIGO stage IV and its special type

Kai Wang,Yaxia Chen

doi:10.1007/s10585-020-10064-w

Abstract

GTN is a group malignant diseases from placental trophoblastic cells. There are very few cases of GTN with FIGO (International Federation of Gynecology and Obstetrics) stage IV all over the world, and the special types (patients with metastatic lesions and with no evidence of GTN neither in genitalia nor in lungs) have rarely been reported. It is necessary to conduct large retrospective studies aimed at exploring the diagnosis, treatment and outcomes of this disease. In this retrospective study, 716 patients with GTN were treated at Zhejiang University School of Medicine Women’s Hospital between January 1999 and September 2019; 26 patients were diagnosed as stage IV GTN; Among the 26 stage IV GTN patients, 5 were defined as the special types. The 5-year OS rate of the total 26 FIGO stage IV GTN patients was 69.0%. There was no significant difference of survival rate between stage IV GTN and its special type. And no significant differences in blood type, antecedent pregnancy type, the interval from last known pregnancy, pretreatment serum HCG (human chorionic gonadotropin) level, maximum diameter of tumors, FIGO score, underwent surgery or not and pathological pattern by the outcomes. Age, number of tumor lesions, primary chemotherapy regimen was EMA-CO or EP-EMA protocol and chemoresponse affected the prognosis significantly. Only number of tumor lesions > 8 was independent prognostic factors associated with poorer OS.

Highlights

GTN is a group malignant diseases from placental trophoblastic cells, including invasive hydatidiform mole, choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT), the latter two types both are intermediate trophoblastic tumors (ITT)
Clinical & Experimental Metastasis (2021) 38:47–59 special metastatic lesions, and there is no evidence of GTN in genitalia or lungs, such cases are discussed as the “special types” in this study
The findings of the research suggested that patients with age less than 40 years, or with number of tumor lesions ≤ 8, or treated with one of EMA-CO, EP-EMA and FAEV regimens as the initial chemotherapy protocol have relatively better survival outcomes

Summary

Introduction

GTN is a group malignant diseases from placental trophoblastic cells, including invasive hydatidiform mole, choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT), the latter two types both are intermediate trophoblastic tumors (ITT). Clinical & Experimental Metastasis (2021) 38:47–59 special metastatic lesions, and there is no evidence of GTN in genitalia or lungs (whether imaging or histopathological examination), such cases are discussed as the “special types” in this study. They may appear when primary focus disappeared and the distant metastatic lesions progressed

Methods

Results

Conclusion