Lung metastases in low-risk gestational trophoblastic neoplasia: a retrospective cohort study.
Adult
Antimetabolites, Antineoplastic
/ administration & dosage
Choriocarcinoma
/ drug therapy
Cohort Studies
Drug Resistance, Neoplasm
/ drug effects
Female
Gestational Trophoblastic Disease
/ drug therapy
Humans
Lung Neoplasms
/ diagnosis
Methotrexate
/ administration & dosage
Middle Aged
Neoplasm Staging
Netherlands
/ epidemiology
Outcome Assessment, Health Care
Pregnancy
Recurrence
Risk Assessment
/ methods
United Kingdom
/ epidemiology
Gestational trophoblastic neoplasia
lung metastases
methotrexate
recurrence
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
accepted:
29
11
2019
pubmed:
4
12
2019
medline:
29
1
2020
entrez:
4
12
2019
Statut:
ppublish
Résumé
Presence of lung metastases in low-risk gestational trophoblastic neoplasia (GTN) is generally considered not to influence prognosis. However, in a recent study in the Netherlands, GTN patients with lung metastases had a higher recurrence rate and more disease-specific deaths compared with patients without metastases. The aim of the present study was to validate these findings in a different country. Historical cohort study. Charing Cross Hospital, United Kingdom. A total of 1040 low-risk GTN patients treated with methotrexate (MTX) between 2002 and 2016 were identified: 65 with lung metastases (group 1) and 975 without metastases (group 2). Baseline characteristics, MTX resistance, survival and recurrence rates were recorded and compared between both groups. MTX resistance, recurrence rate and survival. The occurrence of MTX resistance and median number of MTX courses to achieve remission was significantly higher in patients with lung metastases than patients without metastases (60% versus 38.9%, P = 0.001; and nine versus six courses, P < 0.001). All choriocarcinoma patients (n = 4) with lung metastases developed MTX resistance. The recurrence rate was also higher in group I (9.2% versus 2.7%; P = 0.012). Disease-specific survival was 100% in both groups. The presence of lung metastases at the start of MTX therapy is associated with increased incidence of MTX resistance and recurrence in low-risk GTN without affecting overall survival, which remains 100%. However, individuals with low-risk choriocarcinoma with lung metastases are likely to become resistant to MTX and primary multi-agent chemotherapy should be considered. The presence of lung metastases appears to increase the risk of recurrence in low-risk GTN, but does not affect overall cure rates and survival.
Identifiants
pubmed: 31794098
doi: 10.1111/1471-0528.16036
doi:
Substances chimiques
Antimetabolites, Antineoplastic
0
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
389-395Subventions
Organisme : Cancer Research UK
Pays : United Kingdom
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2019 Royal College of Obstetricians and Gynaecologists.
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