title: Major surgeries performed for gestational trophoblastic neoplasms in a teaching hospital in Tehran, Iran.
abstract: OBJECTIVE
  This study aim was to evaluate indications and outcomes of surgical interventions performed in patients with gestational trophoblastic neoplasm.
  
  
  METHODS
  During January 1995 to December 2005, 110 patients with a diagnosis of persistent gestational trophoblastic neoplasm were treated in our Gynecologic Oncologic Department. Risk score calculation was carried out based on the revised FIGO 2000 scoring system for gestational trophoblastic neoplasm. Data from the patients' records and pathologic reports were analyzed by the chi-square and Fisher's exact tests and logistic regression. The Kaplan-Meier method including the log rank test was used to compare survival and recurrence.
  
  
  RESULTS
  Eight patients did not complete their treatment and were excluded from the study. We evaluated treatment responses and outcomes in 102 patients. Seventy-nine patients (77.5%) responded fully to chemotherapy while 23 patients (22.5%) required surgery. Among 23 patients who underwent surgery, 10 cases (43.5%) had bleeding, and 13 cases (56.5%) had drug resistance. Several factors were found to be significantly different between the groups who responded to chemotherapy and those who needed surgery, including age (p=0.001), antecedent non-molar pregnancy (0.028), tumor stage (p=0.009), and pre-treatment risk scores (p=0.008). But, the total courses of chemotherapy (p=0.521), need to salvage chemotherapy (p=0.074), survival rates (p=0.714), and disease free survival rates (p=0.206) were not significantly different.
  
  
  CONCLUSIONS
  The data suggest that age, antecedent non-molar pregnancy, tumor stage and the prognostic score are clinical predictors of need for surgery. But, it dose not seem that surgery have any effect on the total course of chemotherapy, need for salvage chemotherapy, and patient prognosis.
authors.affiliation: Gynecology Oncology, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Ghaemmaghami
authors.forename: Tahereh
authors.initials: T
authors.lastname: Ashrafgangooei
authors.forename: Mitra Modares
authors.initials: MM
authors.lastname: Gillani
authors.forename: Asamosadat
authors.initials: A
authors.lastname: Mosavi
authors.forename: Nadereh
authors.initials: N
authors.lastname: Behtash