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. 2020 Feb;127(3):389-395.
doi: 10.1111/1471-0528.16036. Epub 2019 Dec 20.

Lung metastases in low-risk gestational trophoblastic neoplasia: a retrospective cohort study

M M Frijstein  1   2   3 , Car Lok  1 , N E van Trommel  1 , M J Ten Kate-Booij  2 , Lfag Massuger  3 , E van Werkhoven  4 , D Short  5 , X Aguiar  5 , R A Fisher  5 , B Kaur  5 , N Sarwar  5 , N J Sebire  5 , M J Seckl  5
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Lung metastases in low-risk gestational trophoblastic neoplasia: a retrospective cohort study

M M Frijstein et al. BJOG. 2020 Feb.

Abstract

Objective: Presence of lung metastases in low-risk gestational trophoblastic neoplasia (GTN) is generally considered not to influence prognosis. However, in a recent study in the Netherlands, GTN patients with lung metastases had a higher recurrence rate and more disease-specific deaths compared with patients without metastases. The aim of the present study was to validate these findings in a different country.

Design: Historical cohort study.

Setting: Charing Cross Hospital, United Kingdom.

Population: A total of 1040 low-risk GTN patients treated with methotrexate (MTX) between 2002 and 2016 were identified: 65 with lung metastases (group 1) and 975 without metastases (group 2).

Methods: Baseline characteristics, MTX resistance, survival and recurrence rates were recorded and compared between both groups.

Main outcome measures: MTX resistance, recurrence rate and survival.

Results: The occurrence of MTX resistance and median number of MTX courses to achieve remission was significantly higher in patients with lung metastases than patients without metastases (60% versus 38.9%, P = 0.001; and nine versus six courses, P < 0.001). All choriocarcinoma patients (n = 4) with lung metastases developed MTX resistance. The recurrence rate was also higher in group I (9.2% versus 2.7%; P = 0.012). Disease-specific survival was 100% in both groups.

Conclusions: The presence of lung metastases at the start of MTX therapy is associated with increased incidence of MTX resistance and recurrence in low-risk GTN without affecting overall survival, which remains 100%. However, individuals with low-risk choriocarcinoma with lung metastases are likely to become resistant to MTX and primary multi-agent chemotherapy should be considered.

Tweetable abstract: The presence of lung metastases appears to increase the risk of recurrence in low-risk GTN, but does not affect overall cure rates and survival.

Keywords: Gestational trophoblastic neoplasia; lung metastases; methotrexate; recurrence.

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References

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    1. Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, et al. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet 2018;143(Suppl 2):79-85.
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    1. McNeish IA, Strickland S, Holden L, Rustin GJ, Foskett M, Seckl MJ, et al. Low-risk persistent gestational trophoblastic disease: outcome after initial treatment with low-dose methotrexate and folinic acid from 1992 to 2000. J Clin Oncol 2002;20:1838-44.
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