Management and prognostic analysis of patients with gestational trophoblastic neoplasia (GTN) in FIGO stage IV and its s
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RESEARCH PAPER
Management and prognostic analysis of patients with gestational trophoblastic neoplasia (GTN) in FIGO stage IV and its special type Kai Wang1 · Yaxia Chen1 Received: 21 July 2020 / Accepted: 8 November 2020 © The Author(s) 2020
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. Keywords Stage IV GTN · Metastatic lesions · Special type · Prognostic factors · Chemoresponse · Immunohistochemistry (IHC)
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). GTN is not common gynecological malignancies, arising from any type of pregnancy, mostly after hydatidiform mole pregnancy, the rest can occur after preterm birth, abortion, term pregnancy and ectopic pregnancy. As the most malignant form, choriocarcinoma usually and early has tumor metastasis, witch is Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10585-020-10064-w) contains supplementary material, which is available to authorized users. * Yaxia Chen [email protected] 1
Department of Oncology, Zhejiang University School of Medicine Women’s Hospital, No. 1 Xueshi Road, Hangzhou, China
mainly after nonmolar pregnancy. The metastatic sites are variety and individual, lungs are the most common, about 80% patients would happen, followed by vaginal in 30%, pelvic in 20%, liver in 10%, and brain in 10%. According to FIGO staging and classification system for GTN in 2000, tumors extend
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