Prognosis of malignant gestational trophoblastic neoplasia: 20 years of experience.

OBJECTIVE

To analyze retrospectively the management and prognosis of malignant gestational trophoblastic neoplasia (GTN) patients treated at Peking Union Medical College (PUMC) Hospital from 1985 to 2005.

STUDY

DESIGN

From 1985 to 2005 1,130 GTN patients were treated at PUMC Hospital. Management and prognosis were analyzed retrospectively. The analyses of prognostic factors were performed by using univariate and multivariate analyses.

RESULTS

Among the 1,130 patients 903 (80.0%) achieved complete remission (CR), 187 (16.5%) partial remission (PR) and 40 (3.5%) died of progress of the disease (PD). Among the CR patients, 31 (3.4%) relapsed later. Of the 187 PR patients, 155 (82.0%) had normal beta-hCG titer but with residual tumor in the lung or other organs. Among them, 6 patients with choriocarcinoma experienced PD after treatment. One hundred thirty-nine patients became pregnant during follow-up, with a total of 159 pregnancies. Among them, abnormal pregnancy rate was 16.4%, molar rate was 3.1% and fetal abnormality rate was 1.6%.

CONCLUSION

Most GTN patients can be cured completely with timely and appropriate chemotherapy treatment. In select cases, surgery should be performed to obtain a better curative outcome. Patients whose residual metastatic tumors remain unchanged after beta-hCG returns to normal are assumed to have CR. We recommend that patients postpone pregnancy for at least 12 months after chemotherapy.