Low‐risk gestational trophoblastic neoplasia – 20 years experience of a state registry.

Autor:	McInerney, Carmel, McNally, Orla, Cade, Thomas James, Jones, Antonia, Neesham, Deborah, Naaman, Yael
Předmět:	RISK assessment OBSTETRICS surgery DRUG resistance in cancer cells CANCER relapse METHOTREXATE ANTINEOPLASTIC agents TREATMENT effectiveness REPORTING of diseases RETROSPECTIVE studies DESCRIPTIVE statistics CANCER chemotherapy ODDS ratio MEDICAL records ACQUISITION of data CHORIONIC gonadotropins COMBINED modality therapy CONFIDENCE intervals GESTATIONAL trophoblastic disease DISEASE incidence TIME DISEASE risk factors
Zdroj:	Australian & New Zealand Journal of Obstetrics & Gynaecology; Jun2024, Vol. 64 Issue 3, p223-229, 7p
Abstrakt:	Background: Gestational trophoblastic disease (GTD) is an uncommon but highly treatable condition. There is limited local evidence to guide therapy. Aims: To report the experience of a statewide registry in the treatment of low‐risk gestational trophoblastic neoplasia (GTN) over a 20‐year period. Materials and Methods: A retrospective review of the prospectively maintained GTD registry database was conducted. There were 144 patients identified with low‐risk GTN, of which 115 were analysed. Patient demographics, treatment details and outcomes, including development of resistance, toxicity or relapse were reviewed. Results: The incidence of GTD was 2.6/1000 live births. There was 100% survival. The mean time from diagnosis to commencing treatment was 1.9 days (range 0–29 days). Seventy‐seven percent of patients treated with methotrexate achieved complete response. Thirteen patients (11.3%) required multi‐agent chemotherapy, for the treatment of resistant or relapsed disease. There was a higher rate of treatment resistance in those with World Health Organization (WHO) risk scores 5–6 (odds ratio (OR) 6.56, 95% CI 1.73–24.27, P = 0.005) and those with pre‐treatment human chorionic gonadotropin >10 000 (OR 4.00 95% CI 1.73–24.27 P = 0.007). Four patients (3.5%) were diagnosed with choriocarcinoma after commencing treatment. Nine patients (7.8%) had successful surgical treatment for GTN, both alone and in combination with chemotherapy. The relapse rate was 4.3%; all were treated successfully with a combination of chemotherapy and surgery, and 93.9% of patients completed follow up through the registry. Conclusions: Methotrexate is a highly effective treatment for low‐risk GTN, especially with WHO risk score ≤4. The optimal treatment for those with risk scores of 5–6 requires further investigation. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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