Abstract 611P
Background
Gestational trophoblastic neoplasia (GTN) patients with WHO risk score ≥13, as well as those with brain, liver, or extensive metastasis fall in the ultra high-risk group. Available data on these patients is limited. This study aims to assess the clinical characteristics and prognosis of this group.
Methods
Information including baseline clinical characteristics, treatment details, and outcomes of consecutive patients with ultra high-risk GTN treated at Tata Medical Center between December 2011 and January 2022 was extracted from the electronic medical records. Descriptive statistics were used for baseline characteristics, and survival was estimated with the Kaplan-Meier method.
Results
Ultra high-risk GTN (n=20) represented 60.6% of total GTN patients. The median age of the cohort was 30 years (range, 19-48). Vaginal bleeding (75%) was the commonest presenting symptom, followed by abdominal pain (70%), cough (60%), and hemoptysis (20%). The antecedent pregnancy resulted in abortion in 9 (45%) patients, while term and molar pregnancy were reported in 4 (20%) and 7 (35%). The median pretreatment beta-hCG value was 168000 IU/L (range, 1078-1431800). Lung (85%) was the commonest site of metastasis, followed by brain and liver (40% each). Ten (50%) patients had a history of failed chemotherapy (30% single-agent, 20% multi-agent). Gentle induction chemotherapy was used for 11 (55%) patients. Fifteen patients (75%) received EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) regimen, and 5 (25%) received platinum-based regimens. Complete response was seen in 17 (85%) patients. Among the 8 patients with brain metastasis, 7 (87.5%) received high-dose methotrexate-based regimens, and 1 (12.5%) received radiotherapy. Three deaths occurred in the entire cohort including 1 early death from pulmonary hemorrhage. At a median follow-up of 56.5 months (95% confidence interval [CI] 43.9-68.9), median overall survival (OS) was not reached. The actuarial 5-year OS was 80%.
Conclusions
The proportion of patients with ultra high-risk GTN was higher than that reported in most institutional studies. Response to chemotherapy and survival remained favorable in this group of patients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.