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Gestational Throphoblastic Neoplasia
Complete Resection Is Essential in the Surgical Treatment of Gestational Trophoblastic Neoplasia
  1. Kathleen Gong Essel, MD*,
  2. Aaron Shafer, MD†,
  3. Amanda Bruegl, MD‡,
  4. David M. Gershenson, MD†,
  5. Lane K. Drury, BA§,
  6. Lois M. Ramondetta, MD†,
  7. R. Wendel Naumann, MD§ and
  8. Jubilee Brown, MD§
  1. *Department of Obstetrics and Gynecology, The University of Oklahoma, Oklahoma City, OK;
  2. †Department of Gynecologic Oncology and Reproductive Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, TX;
  3. ‡Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, OR; and
  4. §Division of Gynecologic Oncology, Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC.
  1. Address correspondence and reprint requests to Jubilee Brown, MD, Division of Gynecologic Oncology, Atrium Health (formerly Carolinas HealthCare System), Levine Cancer Institute, 1021 Morehead Medical Dr, Suite 2100, Charlotte, NC 28204. E-mail: jubilee.brown{at}carolinashealthcare.org.

Abstract

Objective The aim of this study was to determine the utility of surgery in patients with gestational trophoblastic neoplasia (GTN).

Materials and Methods We performed a retrospective institutional review board–approved analysis of all patients with GTN at a single institution from 1985 to 2015 and compared all patients who underwent surgery as definitive management for their disease to a matched cohort of those who did not. Kaplan-Meier curves were used to estimate progression-free survival (PFS) and overall survival (OS).

Results Sixty-nine patients underwent a total of 94 surgeries as definitive treatment for GTN. Nineteen patients had multiple surgeries. Progression-free survival and OS were improved in patients with complete macroscopic surgical resection (n = 61) compared with patients with gross residual disease (n = 33) (median PFS 91.2 months vs 3.3 months, and median OS not reached at 108.8 months vs 66.3 months, respectively; P < 0.05). The nature of the surgery (emergent vs planned) and site of metastatic disease did not influence PFS or OS. Of the 61 patients with no visible residual disease, 17 received adjuvant chemotherapy and 44 did not; there were no observed differences in PFS or OS. Patients who underwent surgery as part of definitive treatment (n = 69 patients) were compared with patients with GTN over the same period who received chemotherapy alone (n = 33 patients). Median PFS was improved in the surgical group (5.9 vs 5.1 months, P < 0.01), but OS was not significantly different (P = 0.37).

Conclusions Complete resection results in improved outcomes in patients who undergo surgery for GTN, whether emergent or planned, independent of disease site, and should be considered as an important component of treatment in some situations.

  • Gestational trophoblastic neoplasia
  • Surgery, Complete resection
  • Choriocarcinoma

https://doi.org/10.1097/IGC.0000000000001348

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    Footnotes

    • The authors declare no conflicts of interest.

    • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).