Ten-Year Review of Gestational Trophoblastic Disease at Lady Reading Hospital, Peshawar

Abstract

Objective: To determine the frequency and management outcome of gestational trophoblastic disease (GTD) in Lady Reading Hospital.

Methods: This was a retrospective observational study at Lady Reading Hospital, Peshawar, from January 2011 to December 2021. Hospital records of all patients with GTD were reviewed and all were included in this study except those with an incomplete record or unconfirmed histology. Treatment was analysed in terms of surgical, chemotherapy or no treatment, and outcomes were noted in terms of complete remission, disease persistence or death.

Results: In 10 years 353 patients were admitted with GTD, and the frequency of the disease was 3.72 cases per 1000 pregnancies. The most frequent lesions were complete mole 65.2% (n=230) followed by invasive mole 20.4% (n=72). Mortality rate was 0.56% (n=2). Maternal blood group analysis revealed that B positive 28.3% (n=100) was more frequent. O positive blood group was found more in the malignant form of the disease at 3.96% (n=14). GTD was most prevalent in 21 to 30 years of age (41.4%, n=146). Regarding treatment, in 69.97% (n=247) of cases, suction and evacuation were performed, in 4.2% (n=15) of cases hysterectomy was performed as primary therapy, and 4.8% (17) needed hysterectomy for chemoresistance. In this study 42.49% (n=150) were given single-agent chemotherapy and 4.8% (n=17) were given multi-agent therapy. We had 21.33% (32) patients with a risk score of 7-9. In the group with a risk score of 7-9, 15.62% (n=5) patients were directly started on multi-agent therapy because of evidence of metastasis or choriocarcinoma; the remaining 84.37% (n=27) of patients who had no evidence of metastasis, no prior chemotherapy, no choriocarcinoma and International Federation of Obstetrics and Gynecology (FIGO) stage 1 were given single-agent methotrexate with folinic acid (eight days) after informed consent. In 18.75% of patients (n=6) hysterectomy was performed as the primary treatment either for haemorrhage or with age > 40, family completed, or reluctance to undergo chemotherapy. They all had a complete cure. In 3.1% (n=1) of cases, resistance to single-agent therapy was found and multi-agent treatment was started. Overall, in 96.29% of patients, complete remission was achieved with single-agent therapy in patients with risk scores of 7-9.

Conclusion: The frequency of GTD was 3.4/1000 pregnancies. Complete mole was the most frequent lesion, and single-agent chemotherapy had a good outcome in low- and high-risk patients with a risk score of 7-9 (with no evidence of metastasis, prior chemotherapy, or choriocarcinoma and FIGO stage 1).

Keywords: choriocarcinoma; complete mole; gestational trophoblastic neoplasia; hydatiform mole; s: gestational trophoblastic disease.

Figure 1. Percentage of gestational trophoblastic disease (GTD) patients according to age

Figure 2. Parity of patients with gestational trophoblastic disease (GTD) (in percentages)