Survival of women with gestational trophoblastic neoplasia and liver metastases: is it improving?
OBJECTIVE
To determine whether survival outcomes of women with liver metastases from gestational trophoblastic neoplasia (GTN) have improved from the previous finding of 27% at 5 years.


METHODS
The Charing Cross GTN database was searched for patients with liver metastases treated between 1975 and 2007. Prognostic variables were recorded and analyzed for effect on survival.


RESULTS
Thirty-eight (1.8%) of 2,100 GTN patients had liver metastases. One patient with placental site trophoblastic tumor was excluded. In the remaining 37 cases the overall survival was 48% at 5 years. Seven patients with very advanced disease died <4 weeks after admission, and 12 late deaths occurred, 5 due to non-GTN causes (1 stroke and 4 second cancers). After exclusion of the early deaths and censoring for the non-GTN related deaths, the cause-specific survival was 68%. No prognostic variable was significant on univariate analysis. However, patients presenting >2.8 years and <2.8 years from the antecedent pregnancy had a 32% and 75% (p = 0.08) chance of long-term survival, respectively.


CONCLUSIONS
The prognosis of patients with liver metastases from GTN has improved. Outcome may be best in those patients presenting within 2.8 years of the causative pregnancy and without very large volumes of disease.
Charing Cross Hospital Gestational Trophoblastic Disease Centre, Imperial College NHS Healthcare Trust, London, UK.
Eliyaz
E
Ahamed
Dee
D
Short
Bernard
B
North
Philip M
PM
Savage
Michael J
MJ
Seckl
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D006063:Chorionic Gonadotropin / Q000097:blood; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000401:mortality* / Q000473:pathology; D006801:Humans; D006918:Hydroxyurea / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary*; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011247:Pregnancy; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom; D014750:Vincristine / Q000008:administration & dosage
D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D006918:Hydroxyurea; D008727:Methotrexate