Prognostic factors associated with ultra-high-risk gestational trophoblastic neoplasia

Philippe Poli, Moi Teaching and Referral Hospital, Kenya
Donah Oeri, Moi University, Kenya
Diana Sheba, Moi University, Kenya
Amina Rh, Moi University, Kenya
Smith Lorenzo, Moi University, Kenya
Richard Mogeni, Moi University, Kenya
Wycliffe Kosgei, Moi University, Kenya
Wilson Aruasa, Moi University, Kenya
Philiph Tonui, Moi University, Kenya
Elkanah Orang'o, Aga Khan University


Introduction: The aim of this study was to determine the prognostic factors associated with ultra-high-risk gestational trophoblastic neoplasia (UHR-GTN). Globally, women diagnosed with UHR-GTN have poor outcomes, despite the disease being the most curable gynecological malignancy.

Methods: This was a hospital-based retrospective study that was carried out at Moi Teaching and referral hospital from 2017 to 2023. The prognostic factors analyzed included patients, treatment, and disease factors.

Results: A total of 14 patients with UHR-GTN had their medical records reviewed. There was a 50% mortality rate. Mortality was higher among patients aged < 40 years old [85.7% vs 14.3%, p=0.23]. A high mortality rate was reported among women with anemia (100%) and septicemia (42.9%). Most patients with an initial ß-hCG of > 1,000,000 died from the disease [85.7% vs 14.3%, p=1.00]. Mortality from patients with liver and brain metastases was equally reported as 42.9% [p=0.56]. Death among those with more than 3 site metastases was 71.4% [p=0.46]. Mortality among those with more than 3 cm metastasis lesions size was 85.7% [p=0.10]. The mortality rate among those who received multimodality treatment was high [57.1% vs 42.9%, p=1.0]. A delay of ≥7 days in initiating and continuing treatment was not statistically associated with mortality [85.7%, p=0.10] and [71.4%, p=1.00], respectively.

Conclusion/Implications: The prognosis of UHR-GTN is poor. The age < 40 years old, anemia, septicemia, and initial ß-hCG level ≥1 million, the number and size of metastatic lesions were not statistically associated with mortality; however, there were reported to have high mortality.