Frontiers in oncology · 2026
Treatment outcomes of gestational choriocarcinoma before and after EMA/CO introduction in Mongolia: a 15-year retrospective cohort study.
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Sukhbat Ulziijargal, Batsuuri Gandolgor, Yamamoto Eiko, Turbat Terkhen, Ulziibaatar Oyujin, Oidov Baatarkhuu, Saragih Ita Daryanti, Ganzul Namuun, Liu Yen-Liang, Badarch Jargalsaikhan
Аннотация
OBJECTIVE: To evaluate the clinical characteristics, metastatic patterns, and treatment outcomes of gestational choriocarcinoma in Mongolia, with a particular focus on the impact of etoposide-methotrexate-actinomycin D/cyclophosphamide-vincristine (EMA/CO) chemotherapy implementation.
METHODS: A retrospective cohort study was conducted including 66 patients diagnosed with gestational choriocarcinoma between 2011 and 2025. Patients were stratified based on FIGO stage and metastatic status. Clinical features, antecedent pregnancy, and treatment outcomes were analyzed. Comparisons between pre-implementation (2011-2017) and post-implementation (2018-2025) cohorts were performed using independent t-test, chi-square test, or Fisher's exact test as appropriate.
RESULTS: Of the 66 patients, 42.4% (n = 28) had non-metastatic disease (FIGO stage I), while 57.6% (n = 38) presented with metastatic disease (FIGO stages II-IV). Vaginal bleeding was the most common presenting symptom (84.8%). The lungs were the most frequent site of metastasis. Following implementation of the EMA/CO chemotherapy regimen in 2018, higher complete remission rates and lower observed mortality were observed in the post-implementation cohort. Complete remission increased from 69.7% (23/33) to 97.0% (32/33) (p = 0.006), while disease-related mortality decreased from 30.3% (10/33) to 3.0% (1/33) (p = 0.006). Chemoresistance and relapse rates also decreased, although these differences were not statistically significant. Additional interventions, including surgery for residual disease and radiotherapy for brain or lung metastases, were applied when indicated. Despite overall improvements, metastatic disease remained a key determinant of prognosis.
CONCLUSION: Patients treated after 2018 demonstrated higher complete remission rates and lower observed mortality compared with those treated before 2018. However, due to the retrospective design, absence of adjusted outcome analysis, and baseline differences between treatment-era cohorts, these findings should be interpreted cautiously. Early diagnosis, routine serum β-hCG surveillance, timely referral, and standardized management remain essential for optimizing outcomes in gestational choriocarcinoma.
METHODS: A retrospective cohort study was conducted including 66 patients diagnosed with gestational choriocarcinoma between 2011 and 2025. Patients were stratified based on FIGO stage and metastatic status. Clinical features, antecedent pregnancy, and treatment outcomes were analyzed. Comparisons between pre-implementation (2011-2017) and post-implementation (2018-2025) cohorts were performed using independent t-test, chi-square test, or Fisher's exact test as appropriate.
RESULTS: Of the 66 patients, 42.4% (n = 28) had non-metastatic disease (FIGO stage I), while 57.6% (n = 38) presented with metastatic disease (FIGO stages II-IV). Vaginal bleeding was the most common presenting symptom (84.8%). The lungs were the most frequent site of metastasis. Following implementation of the EMA/CO chemotherapy regimen in 2018, higher complete remission rates and lower observed mortality were observed in the post-implementation cohort. Complete remission increased from 69.7% (23/33) to 97.0% (32/33) (p = 0.006), while disease-related mortality decreased from 30.3% (10/33) to 3.0% (1/33) (p = 0.006). Chemoresistance and relapse rates also decreased, although these differences were not statistically significant. Additional interventions, including surgery for residual disease and radiotherapy for brain or lung metastases, were applied when indicated. Despite overall improvements, metastatic disease remained a key determinant of prognosis.
CONCLUSION: Patients treated after 2018 demonstrated higher complete remission rates and lower observed mortality compared with those treated before 2018. However, due to the retrospective design, absence of adjusted outcome analysis, and baseline differences between treatment-era cohorts, these findings should be interpreted cautiously. Early diagnosis, routine serum β-hCG surveillance, timely referral, and standardized management remain essential for optimizing outcomes in gestational choriocarcinoma.