Gestational trophoblastic neoplasm: Patient outcomes and clinical pearls from a multidisciplinary referral center Journal Article
| Authors: | Liu, Y. L.; Praiss, A. M.; Chiang, S.; Devereaux, K.; Huang, J.; Rizzuto, G.; Al-Rawi, D.; Weigelt, B.; Jewell, E.; Abu-Rustum, N. R.; Aghajanian, C. |
| Article Title: | Gestational trophoblastic neoplasm: Patient outcomes and clinical pearls from a multidisciplinary referral center |
| Abstract: | Objectives: To describe clinical outcomes and pearls for patients with gestational trophoblastic neoplasm (GTN). Methods: Patients with GTN treated at a referral center from 1/2006 to 12/2022 were included. Clinical characteristics, World Health Organization risk score (low-risk 0–6, high-risk ≥7), and treatments/outcomes were evaluated using summary statistics, stratified by initial treatment at a referral center versus locally. Histologies included complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). Results: Of 189 patients with GTN, 125 were treated initially at a referral center and 64 locally. Median age at diagnosis was 34 years (range, 17–70). Most patients were White (n = 132, 70 %); 80 patients had CHM, 26 PHM, 52 CCA, 11 PSTT, 19 ETT, and 1 ETT/CCA. For low-risk GTN, first-line treatment was primarily methotrexate, although some were cured with repeat dilation and curettage. For high-risk disease, first-line therapy consisted of multiagent chemotherapy regimens at a referral center (n = 18/18) compared to 7 of 15 patients with high-risk GTN treated with methotrexate at local institutions. Patients with low-risk and high-risk disease who received initial care at a tertiary referral institution had cure rates of 100 % (n = 87/87) and 89 % (n = 16/18), respectively, while patients with initial care locally had cure rates of 87 % (n = 33/37) and 47 % (n = 7/15), respectively. Conclusion: GTN is a rare gynecologic malignancy with high cure rates, particularly in low-risk disease. Treatment consolidation at a tertiary referral institution is critical for improved outcomes, particularly in those with high-risk disease or PSTT/ETT. © 2024 Elsevier Inc. |
| Keywords: | adolescent; adult; controlled study; aged; major clinical study; clinical feature; cisplatin; cancer combination chemotherapy; systemic therapy; capecitabine; gemcitabine; paclitaxel; cancer patient; methotrexate; outcome assessment; antineoplastic agent; hysterectomy; carboplatin; low drug dose; etoposide; cyclophosphamide; vincristine; retrospective study; histology; ifosfamide; vinblastine; high risk patient; risk assessment; drug dose escalation; intensive care; cancer regression; minimal residual disease; folinic acid; scoring system; dactinomycin; bleomycin; world health organization; drug dose regimen; choriocarcinoma; caucasian; dilatation and curettage; epithelioid trophoblastic tumor; chorionic gonadotropin; repeat procedure; placental site trophoblastic tumor; clinical outcome; second-line treatment; cancer statistics; first-line treatment; low risk patient; gestational trophoblastic neoplasia; gestational trophoblastic disease; human; female; article; tertiary care center; complete hydatidiform mole; third-line treatment; gestational trophoblastic neoplasm; partial mole |
| Journal Title: | Gynecologic Oncology |
| Volume: | 192 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2025-01-01 |
| Start Page: | 171 |
| End Page: | 177 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2024.12.009 |
| PROVIDER: | scopus |
| PUBMED: | 39674133 |
| PMCID: | PMC11761376 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Ying L. Liu -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
-
131Jewell -
890Abu-Rustum -
215Huang -
610Aghajanian -
31Rizzuto -
641Weigelt -
147Chiang -
106Liu -
8Al-Rawi -
36Praiss
Related MSK Work