[Outcome of gestational trophoblastic neoplasia patients with residual lung tumor after completion of treatment].
OBJECTIVE
To analyze retrospectively the prognosis of gestational trophoblastic neoplasia (GTN) patients who achieved normal human chorionic gonadotropin-beta subunit (beta-hCG) titer after completing treatment but remained with residual lung tumor.


METHODS
A total of 1130 GTN patients were hospitalized at Peking Union Medical College Hospital from Jan 1985 to Jan 2004. Among these patients, 901 achieved complete remission (CR); 152 achieved normal blood beta-hCG titer after the completion of treatment but remained with residual lung tumor (defined as partial remission). Retrospective analyses were carried out on the 152 patients. Statistical analysis was used to compare the recurrent rate of the CR patients with the progression rate of the 152 patients.


RESULTS
The blood beta-hCG level of all the 152 patients returned to normal after they received 1-30 courses of standard multiple-drug combined chemotherapy treatment. Another 0-8 courses of chemotherapy were applied to these patients before they left hospital. Seventeen of the 152 patients lost to follow-up. Of the rest 135 patients followed up for 14 to 110 months, 83 showed no significant changes in terms of their residual tumors; the residual tumors in 46 patients diminished or disappeared; and the other 6 patients had progression of disease (PD), with beta-hCG levels going up 6-8 months after completing treatment (increased lung metastases were observed in four of the six patients). There was no significant difference (P > 0.05) between the recurrent rate [3.4% (31/901)] of the 901 CR patients and the progression rate [3.9% (6/152)] of the 152 patients. There was also no significant difference (P > 0.05) between the recurrent rate [2.2% (10/463)] of the CR patients with lung metastasis and the progression rate of the 152 patients.


CONCLUSIONS
After normalization of beta-hCG titer, patients whose lung tumors remained unchanged even after several additional courses of chemotherapy should be considered as CR patients. Follow-ups should be strictly carried out on these patients, especially at around 6 months after the completion of treatment, and particularly for high-risk and drug-resistant choriocarcinoma patients.
Yang
Jun-jun
JJ
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Xiang
Yang
Y
Wan
Xi-run
XR
Li
Jun-gao
JG
Yang
Xiu-yu
XY
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000556:secondary*; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies
D018997:Chorionic Gonadotropin, beta Subunit, Human; D005472:Fluorouracil; D008727:Methotrexate