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Gestational trophoblastic neoplasia: does centralization of care impact clinical management?
  1. Cristina Mitric1,2,3,
  2. Kelsey Yang1,2,3,
  3. Gita Bhat4,
  4. Stephanie Lheureux4,
  5. Stephane Laframboise1,2,3,
  6. Xuan Li5 and
  7. Geneviève Bouchard-Fortier1,2,3
  1. 1 Sinai Health, Toronto, Ontario, Canada
  2. 2 Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
  3. 3 Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
  4. 4 Medical Oncology, Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
  5. 5 Department of Biostatistics, Princess Margaret Cancer Centre/ University Health Network, Toronto, Ontario, Canada
  1. Correspondence to Dr Cristina Mitric, Gynecology Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada; cristina.mitric{at}


Objective International societies advocate for gestational trophoblastic neoplasia referral to designated expert centers. This study assessed the impact of centralization of trophoblastic care on clinical outcomes.

Methods A centralized program was implemented in 2018 at two affiliated academic hospitals, Princess Margaret Cancer Center and Mount Sinai Hospital. A retrospective analysis of patients treated between 2000 and 2022 was performed and the clinical outcomes were compared before (2000–2017) and after (2018–2022) centralization. Statistical analyses were performed with significance set as p<0.05.

Results A total of 94 patients with trophoblastic neoplasia were included: 60 pre-centralization and 34 post-centralization, 79.8% low-risk and 18.1% high-risk. Centralization led to significant improvement for: (1) accurate score documentation (from 37.9% to 89.3%,); (2) contraception counseling (from 67.2% to 96.7%); (3) median time from diagnosis to chemotherapy (from 9 days to 1 day); and (4) incomplete follow-up (from 20.7% to 3.3%) (all p<0.05). First-line chemotherapy for low-risk neoplasia was dactinomycin in 47.9% and 87.0% pre- and post-centralization, respectively (p=0.005). The median number of chemotherapy cycles decreased from seven to four (p=0.01), and the median number of consolidation cycles increased from two to three (p<0.001). Serum human chorionic gonadotropin (hCG) levels of 10 000–100 000 IU/L were significantly associated with longer time to hCG normalization and higher risk of resistance to first-line chemotherapy compared with hCG levels <1000 IU/L.

Conclusion Centralization of trophoblastic neoplasia care leads to greater guideline compliance, faster chemotherapy initiation, fewer chemotherapy cycles with optimized consolidation, and enhanced surveillance completion. This supports the establishment of trophoblastic neoplasia expert centers.

  • gestational trophoblastic disease
  • hydatidiform mole, invasive

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors CM: conceptualization, data curation, investigation, methodology, statistical analysis, writing (original draft). KY: data curation, investigation, writing (original draft). XL: statistical analysis, writing (review). GB, SLh, SLa: conceptualization, writing (review and editing). GB-F: conceptualization, investigation, methodology, project administration, supervision, writing (review and editing), guarantor.

  • Funding A research award was received for this study from the Mount Sinai Hospital, specifically the 2022 Joan Murphy Research Award Funding.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.