Introduction To evaluate the prognosis and recurrence in initially treated patients with pulmonary metastasis from gestational trophoblastic neoplasia (GTN), and to explore the clinical significance of pulmonary resection.

Methods Retrospective analysis was performed on 606 GTN patients with pulmonary metastasis who received standardized chemotherapy as initial treatment in Peking Union Medical College Hospital (PUMCH) from January 2002 to December 2018. The patients were divided into the surgery (51 patients) and non-surgery groups (555 patients). The prognosis of these patients was compared. Risk factors affecting recurrence were analyzed to explore the effect of pulmonary resection.

Results Among low-risk patients, CR rate is 100% and recurrence rate is below 1% in both groups .Among high-risk patients, CR rate and recurrence rate are 93.5% and 10.3% in the surgery group and 94.7% and 14.3% in the non-surgery group, respectively.There was no significant difference in all prognosis features between the two groups.(all with P>0.05). No significant difference was found in recurrence rates considering the recurrence risk factors(≥3.2 cm residual lung lesions; FIGO score≥9.0;drug resistance) between the two groups (all with P>0.05).

Conclusion/Implications After standardized chemotherapy, pulmonary resection is not necessary for initially treated stage III GTN patients whose blood β-hCG drop to normal levels and residual lung lesions remain stable . These patients should be closely monitored during the follow-up regardless of the size of residual lung lesions or high/low risk score, especially within 1 year after CR.