Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1136/ijgc-2020-001237 http://hdl.handle.net/11449/201777 |
Resumo: | Background South America has a higher incidence of gestational trophoblastic disease than North America or Europe, but whether this impacts chemotherapy outcomes is unclear. The purpose of this study was to evaluate outcomes among women with high-risk gestational trophoblastic neoplasia (GTN) treated at trophoblastic disease centers in developing South American countries. Methods This retrospective cohort study included patients with high-risk GTN treated in three trophoblastic disease centers in South America (Botucatu and Rio de Janeiro, Brazil, and Buenos Aires, Argentina) from January 1990 to December 2014. Data evaluated included demographics, clinical presentation, FIGO stage, WHO prognostic risk score, and treatment-related information. The primary treatment outcome was complete sustained remission by 18 months following completion of therapy or death. Results Among 1264 patients with GTN, 191 (15.1%) patients had high-risk GTN and 147 were eligible for the study. Complete sustained remission was ultimately achieved in 87.1% of cases overall, including 68.4% of ultra high-risk GTN (score ≥12). Early death (within 4 weeks of initiating therapy) was significantly associated with ultra high-risk GTN, occurring in 13.8% of these patients (p=0.003). By Cox's proportional hazards regression, factors most strongly related to death were non-molar antecedent pregnancy (RR 4.35, 95% CI 1.71 to 11.05), presence of liver, brain, or kidney metastases (RR 4.99, 95% CI 1.96 to 12.71), FIGO stage (RR 3.14, 95% CI 1.52 to 6.53), and an ultra-high-risk prognostic risk score (RR 7.86, 95% CI 2.99 to 20.71). Median follow-up after completion of chemotherapy was 4 years. Among patients followed to that timepoint, the probability of survival was 90% for patients with high-risk GTN (score 7-11) and 60% for patients with ultra-high-risk GTN (score ≥12). Conclusion Trophoblastic disease centers in developing South American countries have achieved high remission rates in high-risk GTN, but early deaths remain an important problem, particularly in ultra-high-risk GTN. |
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Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South Americagestational trophoblastic diseasetrophoblastic neoplasmsBackground South America has a higher incidence of gestational trophoblastic disease than North America or Europe, but whether this impacts chemotherapy outcomes is unclear. The purpose of this study was to evaluate outcomes among women with high-risk gestational trophoblastic neoplasia (GTN) treated at trophoblastic disease centers in developing South American countries. Methods This retrospective cohort study included patients with high-risk GTN treated in three trophoblastic disease centers in South America (Botucatu and Rio de Janeiro, Brazil, and Buenos Aires, Argentina) from January 1990 to December 2014. Data evaluated included demographics, clinical presentation, FIGO stage, WHO prognostic risk score, and treatment-related information. The primary treatment outcome was complete sustained remission by 18 months following completion of therapy or death. Results Among 1264 patients with GTN, 191 (15.1%) patients had high-risk GTN and 147 were eligible for the study. Complete sustained remission was ultimately achieved in 87.1% of cases overall, including 68.4% of ultra high-risk GTN (score ≥12). Early death (within 4 weeks of initiating therapy) was significantly associated with ultra high-risk GTN, occurring in 13.8% of these patients (p=0.003). By Cox's proportional hazards regression, factors most strongly related to death were non-molar antecedent pregnancy (RR 4.35, 95% CI 1.71 to 11.05), presence of liver, brain, or kidney metastases (RR 4.99, 95% CI 1.96 to 12.71), FIGO stage (RR 3.14, 95% CI 1.52 to 6.53), and an ultra-high-risk prognostic risk score (RR 7.86, 95% CI 2.99 to 20.71). Median follow-up after completion of chemotherapy was 4 years. Among patients followed to that timepoint, the probability of survival was 90% for patients with high-risk GTN (score 7-11) and 60% for patients with ultra-high-risk GTN (score ≥12). Conclusion Trophoblastic disease centers in developing South American countries have achieved high remission rates in high-risk GTN, but early deaths remain an important problem, particularly in ultra-high-risk GTN.Botucatu Trophoblastic Disease Center Botucatu Medical School Sao Paulo State University Julio de Mesquita Filho-UNESPRio de Janeiro Trophoblastic Disease Center Maternity School of Rio de Janeiro Federal UniversityCarlos G Durand Hospital Trophoblastic Disease Center Faculty of Medicine University of Buenos AiresBotucatu Medical School Sao Paulo State University Julio de Mesquita Filho-UNESPUniversity of CaldasSão Paulo Hospital Trophoblastic Disease Center Escola Paulista de Medicina Universidade Federal de São PauloDivision of Gynecologic Oncology Department of Obstetrics Gynecology and Reproductive Biology New England Trophoblastic Disease Center Brigham and Women's Hospital Harvard Medical SchoolBotucatu Trophoblastic Disease Center Botucatu Medical School Sao Paulo State University Julio de Mesquita Filho-UNESPBotucatu Medical School Sao Paulo State University Julio de Mesquita Filho-UNESPUniversidade Estadual Paulista (Unesp)Maternity School of Rio de Janeiro Federal UniversityUniversity of Buenos AiresUniversity of CaldasUniversidade Federal de São Paulo (UNIFESP)Harvard Medical SchoolMaestá, Izildinha [UNESP]De Freitas Segalla Moreira, Marjory [UNESP]Rezende-Filho, JorgeBianconi, Maria InésJankilevich, GustavoOtero, SilvinaCorrea Ramirez, Luz Angela [UNESP]Sun, Sue YazakiElias, KevinHorowitz, NeilBraga, AntonioBerkowitz, Ross2020-12-12T02:41:31Z2020-12-12T02:41:31Z2020-09-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article1366-1371http://dx.doi.org/10.1136/ijgc-2020-001237International Journal of Gynecological Cancer, v. 30, n. 9, p. 1366-1371, 2020.1525-14381048-891Xhttp://hdl.handle.net/11449/20177710.1136/ijgc-2020-0012372-s2.0-85085060767Scopusreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengInternational Journal of Gynecological Cancerinfo:eu-repo/semantics/openAccess2024-08-16T14:06:43Zoai:repositorio.unesp.br:11449/201777Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-08-16T14:06:43Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America |
title |
Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America |
spellingShingle |
Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America Maestá, Izildinha [UNESP] gestational trophoblastic disease trophoblastic neoplasms |
title_short |
Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America |
title_full |
Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America |
title_fullStr |
Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America |
title_full_unstemmed |
Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America |
title_sort |
Outcomes in the management of high-risk gestational trophoblastic neoplasia in trophoblastic disease centers in South America |
author |
Maestá, Izildinha [UNESP] |
author_facet |
Maestá, Izildinha [UNESP] De Freitas Segalla Moreira, Marjory [UNESP] Rezende-Filho, Jorge Bianconi, Maria Inés Jankilevich, Gustavo Otero, Silvina Correa Ramirez, Luz Angela [UNESP] Sun, Sue Yazaki Elias, Kevin Horowitz, Neil Braga, Antonio Berkowitz, Ross |
author_role |
author |
author2 |
De Freitas Segalla Moreira, Marjory [UNESP] Rezende-Filho, Jorge Bianconi, Maria Inés Jankilevich, Gustavo Otero, Silvina Correa Ramirez, Luz Angela [UNESP] Sun, Sue Yazaki Elias, Kevin Horowitz, Neil Braga, Antonio Berkowitz, Ross |
author2_role |
author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) Maternity School of Rio de Janeiro Federal University University of Buenos Aires University of Caldas Universidade Federal de São Paulo (UNIFESP) Harvard Medical School |
dc.contributor.author.fl_str_mv |
Maestá, Izildinha [UNESP] De Freitas Segalla Moreira, Marjory [UNESP] Rezende-Filho, Jorge Bianconi, Maria Inés Jankilevich, Gustavo Otero, Silvina Correa Ramirez, Luz Angela [UNESP] Sun, Sue Yazaki Elias, Kevin Horowitz, Neil Braga, Antonio Berkowitz, Ross |
dc.subject.por.fl_str_mv |
gestational trophoblastic disease trophoblastic neoplasms |
topic |
gestational trophoblastic disease trophoblastic neoplasms |
description |
Background South America has a higher incidence of gestational trophoblastic disease than North America or Europe, but whether this impacts chemotherapy outcomes is unclear. The purpose of this study was to evaluate outcomes among women with high-risk gestational trophoblastic neoplasia (GTN) treated at trophoblastic disease centers in developing South American countries. Methods This retrospective cohort study included patients with high-risk GTN treated in three trophoblastic disease centers in South America (Botucatu and Rio de Janeiro, Brazil, and Buenos Aires, Argentina) from January 1990 to December 2014. Data evaluated included demographics, clinical presentation, FIGO stage, WHO prognostic risk score, and treatment-related information. The primary treatment outcome was complete sustained remission by 18 months following completion of therapy or death. Results Among 1264 patients with GTN, 191 (15.1%) patients had high-risk GTN and 147 were eligible for the study. Complete sustained remission was ultimately achieved in 87.1% of cases overall, including 68.4% of ultra high-risk GTN (score ≥12). Early death (within 4 weeks of initiating therapy) was significantly associated with ultra high-risk GTN, occurring in 13.8% of these patients (p=0.003). By Cox's proportional hazards regression, factors most strongly related to death were non-molar antecedent pregnancy (RR 4.35, 95% CI 1.71 to 11.05), presence of liver, brain, or kidney metastases (RR 4.99, 95% CI 1.96 to 12.71), FIGO stage (RR 3.14, 95% CI 1.52 to 6.53), and an ultra-high-risk prognostic risk score (RR 7.86, 95% CI 2.99 to 20.71). Median follow-up after completion of chemotherapy was 4 years. Among patients followed to that timepoint, the probability of survival was 90% for patients with high-risk GTN (score 7-11) and 60% for patients with ultra-high-risk GTN (score ≥12). Conclusion Trophoblastic disease centers in developing South American countries have achieved high remission rates in high-risk GTN, but early deaths remain an important problem, particularly in ultra-high-risk GTN. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-12-12T02:41:31Z 2020-12-12T02:41:31Z 2020-09-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1136/ijgc-2020-001237 International Journal of Gynecological Cancer, v. 30, n. 9, p. 1366-1371, 2020. 1525-1438 1048-891X http://hdl.handle.net/11449/201777 10.1136/ijgc-2020-001237 2-s2.0-85085060767 |
url |
http://dx.doi.org/10.1136/ijgc-2020-001237 http://hdl.handle.net/11449/201777 |
identifier_str_mv |
International Journal of Gynecological Cancer, v. 30, n. 9, p. 1366-1371, 2020. 1525-1438 1048-891X 10.1136/ijgc-2020-001237 2-s2.0-85085060767 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
International Journal of Gynecological Cancer |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
1366-1371 |
dc.source.none.fl_str_mv |
Scopus reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
|
_version_ |
1808128124346433536 |