Objectives To reveal negative clinical course and prognostic factors of persistent trophoblastic disease (PTD).
Methods Retrospective analysis of 141 patients diagnosed with PTD from 1996 to 2012, treated at Troghoblastic Disease Center of N.N.Blokhin NMRC of Oncology. 129 (91,5%) patients were low-risk disease, 12 (8,5%) - high-risk. Low risk PTD was treated with methotrexate regimen, high-risk - EMA-CO regimen.
Results Before obtaining care in Blokhin Center 40 (28,4%) patients underwent repeat uterine evacuation, 13 (9,2%) - hysterectomy; 13 (9,2%) patients were treated with nonstandard regimens, 7 (5%) underwent prophylactic chemotherapy. Absence of b-hCG follow-up after molar evacuation was detected in 31 (22%) cases. We estimated that the absence of b-hCG monitoring delayed PTD diagnostic by 2,5 months and increased risk of metastases, hysterectomy and multi agent chemotherapy in 2,5; 5 and 7,4 times resp. Repeat curettage delays PTD diagnostic by 6 weeks and increases risk of resistance in 2,5 times. Hysterectomy delays standard chemotherapy by 3 months and increases risk of metastatic disease in 3,2 times; the resistance occurs 3,5 times often. Nonstandard chemotherapy regimens delayed standard treatment by 13 months, the resistance was increased in 2,5 times; 70% of patients underwent multi-agent chemotherapy. Complete remission rate for low-risk PTD is 100% and for high-risk - 92%.
Conclusions Absence of b-hCG follow-up, repeat curettage, prophylactic chemotherapy, hysterectomy and nonstandard chemotherapy regimens are negative clinical course and prognostic factors for PTD.
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