Treatment outcomes in patients with low risk gestational trophoblastic neoplasia at Sanpasitthiprasong hospital.
Abstract
Objective : To evaluate the treatment outcomes in patients with low-risk gestational trophoblastic neoplasia (LR-GTN) at Sanpasitthiprasong hospital, Thailand.
Methods : Medical records of women diagnosed with LR-GTN at Sanpasitthiprasong hospital from October 1, 2011 - July 1, 2018 until complete sample sizes were retrospectively reviewed. Demographic data, disease diagnosis with the pathological findings confirm that a hydatidiform mole, invasive mole, or choriocarcinoma, treatment and follow up data were analyzed. 30 samples were analyzed in percentage, mean, standard deviation, Odds ratio and survival curve.
Results : A total of 30 cases of LR-GTN were reviewed. The mean age of patients was 32.36 years, mostly in the first gravid (33.33%). The previous pregnancy was complete hydatidiform mole (CHM) 76.67%. B-hCG hormone at diagnosed of GTN less than 1,000 mIU/ml 46.67% (mean 29,910.92). Most patients were stage 1. The WHO prognostic score was two, 33.33%. The first line chemotherapy were methotrexate and actinomycin-D 50% each. Most of the patients were remission at the 6th, 7th, and 8th week, 13.3% each. Five patients (16.67%) did not respond to first line chemotherapy. But when switching to second line chemotherapy all patients were complete remission.
Patients receiving chemotherapy less than or equal to 5 cycles had a greater remission rate than those who received chemotherapy more than 5 cycles (p < 0.01). The single chemotherapy groups, the remission rates were 4.78 times more than the two chemotherapy groups (p < 0.01). Groups with B-hCG values less than 1,000 mIU/ml will have a chance remission 3.04 times than the B-hCG groups of 1,000 mIU/ml and above (p = 0.03). Patients aged 50 years and older were more likely to be diagnosed GTN from the pathological results of 16 times (p = 0.01) than those younger than 50 years.
Conclusion : LR-GTN treatment at Sanpasitthiprasong hospital showed excellent clinical outcomes (100% remission). Single agent chemotherapy, chemotherapy cycles less than or equal to 5 cycles and pre-treatment B-hCG less than 1,000 mIU/ml were the significant factors for the good outcomes.
Keywords : low-risk gestational trophoblastic neoplasia, treatment
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