Recurrent gestational trophoblastic tumor: management and risk factors for recurrence.
OBJECTIVE
To analyze retrospectively the management of recurrent gestational trophoblastic tumor (GTT) patients and evaluate the recurrence associated risk factors.


METHODS
901 gestational trophoblastic tumor (GTT) patients who received treatment at Peking Union Medical College Hospital from January 1985 to January 2004 achieved complete remission (CR). Among them, thirty-one (31/901) relapsed later. Retrospective analyses were carried out on the 31 patients, and multiple regression models were used to identify the risk factors for recurrence.


RESULTS
In all 31 patients, recurrences occurred 6 to 72 months (15.3 months on average) after completing treatment. Of the 25 patients who received treatment again in our hospital, 21 achieved CR, 3 achieved partial remission (PR), and 1 died of progression of disease (PD). Among the 21 CR patients, 4 relapsed repeatedly. The four recurrence associated risk factors identified by multivariate analysis were clinical stage (P<0.05), an interval of more than 12 months between the end of antecedent pregnancy and the start of chemotherapy (odds ratio=3.170, P<0.05), a negative blood beta-hCG titer after seven courses of chemotherapy (odds ratio=4.475, P<0.05), and a less than two courses of consolidation chemotherapy (odds ratio=0.441, P<0.05).


CONCLUSIONS
More attention should be given to GTT patients with recurrence associated risk factors. Combination therapy for GTT treatment is effective. In the study, it was demonstrated that certain risk factors were associated with relapse. These factors may need to be integrated into treatment algorithms.
Yang
Junjun
J
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China.
Xiang
Yang
Y
Wan
Xirun
X
Yang
Xiuyu
X
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014750:Vincristine / Q000008:administration & dosage
D018997:Chorionic Gonadotropin, beta Subunit, Human; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D005472:Fluorouracil; D008727:Methotrexate