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. 2022 Dec 7;11(24):7270.
doi: 10.3390/jcm11247270.

Management and Predictors of Treatment Failure in Patients with Chemo-Resistant/Relapsed Gestational Trophoblastic Neoplasia with Lung Metastasis

Yujia Kong  1 , Weidi Wang  1 , Jinkai Lin  1 , Xirun Wan  1 , Fengzhi Feng  1 , Tong Ren  1 , Jun Zhao  1 , Junjun Yang  1 , Yang Xiang  1
Affiliations

Management and Predictors of Treatment Failure in Patients with Chemo-Resistant/Relapsed Gestational Trophoblastic Neoplasia with Lung Metastasis

Yujia Kong et al. J Clin Med. .

Abstract

The aim of the study was to assess the effectiveness of a combined treatment modality of salvage chemotherapy and pulmonary resection in chemo-resistant/relapsed gestational trophoblastic neoplasia (GTN) with lung metastasis and identify predictors of treatment failure. Data of patients with chemo-resistant/relapsed GTN with lung metastasis who received salvage chemotherapy combined with pulmonary resection were retrospectively analyzed. Among 134 included patients, the number of preoperative chemotherapy regimens ranged from 2−8 (median, 3), and courses ranged from 4−37 (median, 14). Pulmonary lobectomies, segmentectomies, wedge resections, and lobectomies plus wedge resections were performed in 84, 5, 35, and 10 patients, respectively. After completion of treatment, 130 (97.0%) patients achieved complete remission. In the entire cohort, the 5-year overall survival (OS) rate was 87.6%. OS rates were similar between stage III and stage IV disease cohorts (89.4% vs. 75.0%, p = 0.137). Preoperative β-human chorionic gonadotropin (β-hCG) levels > 10 IU/L (p = 0.027) and number of preoperative chemotherapy regimens > 3 (p = 0.018) were predictors of treatment failure. The combined treatment modality of salvage chemotherapy and pulmonary resection is effective in patients with chemo-resistant/relapsed GTN with lung metastasis, improving their prognoses. Patients with preoperative serum β-hCG >10 IU/L and those with >3 chemotherapy regimens preoperatively may not benefit from this multidisciplinary treatment.

Keywords: chemo-resistance; gestational trophoblastic neoplasia; lung metastasis; pulmonary resection; relapse; salvage chemotherapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The diagram of patient selection process. GTN, gestational trophoblastic neoplasia; IM, invasive mole; CC, choriocarcinoma; PSTT, placental site trophoblastic tumor; ETT, epithelioid trophoblastic tumor.
Figure 2
Figure 2
Kaplan–Meier curve showing the overall survival of the study population (N = 134).
See this image and copyright information in PMC

References

    1. Seckl M.J., Sebire N.J., Berkowitz R.S. Gestational trophoblastic disease. Lancet. 2010;376:717–729. doi: 10.1016/S0140-6736(10)60280-2. - DOI - PubMed
    1. Lurain J.R. Gestational trophoblastic disease I: Epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am. J. Obstet. Gynecol. 2010;203:531–539. doi: 10.1016/j.ajog.2010.06.073. - DOI - PubMed
    1. Ngan H.Y.S., Seckl M.J., Berkowitz R.S., Xiang Y., Golfier F., Sekharan P.K., Lurain J.R., Massuger L. Update on the diagnosis and management of gestational trophoblastic disease. Int. J. Gynecol. Obstet. 2018;143((Suppl. S2)):79–85. doi: 10.1002/ijgo.12615. - DOI - PubMed
    1. Eysbouts Y.K., Bulten J., Ottevanger P.B., Thomas C.M., Ten Kate-Booij M.J., van Herwaarden A.E., Siebers A.G., Sweep F.C., Massuger L.F. Trends in incidence for gestational trophoblastic disease over the last 20 years in a population-based study. Gynecol. Oncol. 2016;140:70–75. doi: 10.1016/j.ygyno.2015.11.014. - DOI - PubMed
    1. Smith H.O. Gestational trophoblastic disease epidemiology and trends. Clin. Obstet. Gynecol. 2003;46:541–556. doi: 10.1097/00003081-200309000-00006. - DOI - PubMed

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