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Original research
Age and racial differences in the presentation of gestational trophoblastic neoplasia
  1. Elisabeth Diver1,
  2. Michael Richardson1,
  3. Cheng-I Liao2,
  4. Amandeep K Mann3,
  5. Kathleen M Darcy4,5,
  6. Chunqiao Tian4,5,
  7. Daniel S Kapp1 and
  8. John K Chan3
  1. 1 Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
  2. 2 Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
  3. 3 Department of Obstetrics and Gynecology, California Pacific & Palo Alto Medical Foundation/Sutter Cancer Research Institute, San Francisco, California, USA
  4. 4 Gynecologic Cancer Center of Excellence, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  5. 5 Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, Maryland, USA
  1. Correspondence to Dr Elisabeth Diver, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University, 900 Blake Wilbur Drive, Stanford, CA 94304, USA; elisabeth.diver{at}stanford.edu

Abstract

Objective Gestational trophoblastic neoplasia are a group of diseases with few data given their rarity. The aim of this study was to determine the age and racial differences in the presentation and survival of patients with gestational trophoblastic neoplasia in the United States.

Methods Data were collected from the National Cancer Database from January 2004 to December 2014. Chi-square tests, Cox regression, and Kaplan–Meier models were performed. Demographic characteristics included age at diagnosis, race, insurance status, facility location and type, community median income, high school dropout rate, education, income, and population density data.

Results There were 1004 eligible patients including 64% white (n=645), 23% black (n=233), and 8.3% Asian patients (n=83). Median age was 30.8 (range 14–59) years. Stage I, II, III, IV, and unknown were diagnosed in 32%, 5.4%, 30%, 18%, and 15% of patients, respectively, with 5-year survival of 99%, 93%, 94%, 72%, and 95%, respectively (p<0.001). Compared with national birth rates, those with gestational trophoblastic neoplasia were overrepresented at younger (age 10–19 years: 8.2% vs 4.8%) and older ages (age 40–54 years: 17% vs 3.3%). The extremes of age at presentation were more pronounced in black patients with gestational trophoblastic neoplasia (age 10–19 years: 11% vs 6.9%, 40–54 years: 18% vs 3.2%), and black patients constituted 23% of patients compared with 15% of births nationwide. Some 59% of patients were treated at Academic/Research Programs. Only 6/448 (1.3%) facilities treated more than one patient per year, and only 9% (n=92) of patients were treated at one of these high-volume facilities. On multivariable analysis, older age, higher Charlson/Deyo co-morbidity score, and higher stage disease were independently associated with worse survival (all p<0.001).

Conclusions Gestational trophoblastic neoplasia was disproportionately higher in those at extremes of age and in black women as compared with United States national data. The lack of centralization of care justifies the need to develop regional centers of excellence for this rare malignancy.

  • genital neoplasms
  • female
  • trophoblastic disease
  • gestational trophoblastic disease
  • trophoblastic neoplasms

https://doi.org/10.1136/ijgc-2020-002105

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    Footnotes

    • Contributors Conceptualization: ED, MR, C-IL, DSK, JKC. Formal analysis and methodology: ED, MR, C-IL, AKM, JKC. Visualization: ED, MR, JKC. Investigation: ED, MR, C-IL, AKM, KD, CT, DSK, JKC. Funding acquisition: JKC. Writing original draft: ED, MR, JKC. Writing, review, editing: ED, MR, C-IL, AKM, KD, CT, DSK, JKC.

    • Funding This research was supported by the Fisher Family Fund and Denise Cobb Hale Chair for administrative support. A version of this work was presented at the Society for Gynecologic Oncology 2019 conference and the International Society for the Study of Trophoblastic Disease 2019 conference.

    • Disclaimer The views expressed herein are those of the authors and do not reflect the official policy of the Uniformed Services University, the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., the Department of Army/Navy/Air Force, the Department of Defense, or the U.S. Government.

    • Competing interests ED: personal fees from Clovis Oncology and Glaxosmithkline. JKC: personal fees from AbbVie, Acerta, Aravive, AstraZeneca, Clovis, Eisai, Glaxosmithkline, Merck, and Roche.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Data are derived from the National Cancer Database.