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