Role of Adjuvant Hysterectomy in Management of High-Risk Gestational Trophoblastic Neoplasia

Abstract

The objectives of the study were to investigate the role of and indications for adjuvant hysterectomy in patients with high-risk gestational trophoblastic neoplasia. We retrospectively analyzed records of patients identified as having undergone adjuvant hysterectomy for high-risk gestational trophoblastic neoplasia at First Hospital of Xi'an Jiaotong University, Xi'an, China, between 1985 and 2005. Therapeutic response was defined as complete with normalization of human chorionic gonadotropin (hCG) concentration, partial response with a decrease of more than 50%, and no response with a decrease of 50% or less. Complete remission was defined as normal hCG at 3 consecutive weekly assays without clinical evidence of disease. A total of 21 patients (72.4%) showed an initial therapeutic response after surgery and 8 (27.6%) had no response. The initial therapeutic response was complete in 8 patients (27.6%) and partial in 13 (44.8%). During follow-up of 6 to 168 months, all 21 patients with an initial response and 2 of 8 patients without an initial response ultimately achieved complete remission (23 of 29 patients, 79.3%). Three patients (10.3%) had recurrence after primary remission; 2 patients (6.90%) died. Metastases outside of lungs or pelvic organs, number of metastases, presurgery chemoresistance to multidrug regimens, especially with 2 or more failed protocols, were considered possible reasons for decreased effectiveness of hysterectomy. Our study suggests that timely adjuvant hysterectomy is likely to benefit cautiously selected patients with high-risk gestational trophoblastic neoplasia. Although preoperative metastases limited to pelvic organs or lungs should not be considered an absolute contraindication, adjuvant hysterectomy should generally not be performed in the presence of distant metastases beyond the pelvic organs and lungs.