title: Prognostic factors associated with time to hCG remission in patients with low-risk postmolar gestational trophoblastic neoplasia.
abstract: OBJECTIVE
  The purpose of this study was to identify the clinical factors associated with time to hCG remission among women with low-risk postmolar GTN.
  
  
  METHODS
  This study included a non-concurrent cohort of 328 patients diagnosed with low-risk postmolar GTN according to FIGO 2002 criteria. Associations of time to hCG remission with history of prior mole, molar histology, time to persistence, use of D&C at persistence, presence of metastatic disease, FIGO score, hCG values at persistence, type of first line therapy and use of multiagent chemotherapy were investigated with both univariate and multivariate analyses.
  
  
  RESULTS
  Overall median time to remission was 46 days. Ten percent of the patients required multi-agent chemotherapy to achieve hCG remission. Multivariate analysis incorporating the variables significant on univariate analysis confirmed that complete molar histology (HR 1.45), metastatic disease (HR 1.66), use of multi-agent therapy (HR 2.00) and FIGO score (HR 1.82) were associated with longer time to remission. There was a linear relationship between FIGO score and time to hCG remission. Each 1-point increment in FIGO score was associated with an average 17-day increase in hCG remission time (95% CI: 12.5-21.6).
  
  
  CONCLUSIONS
  Complete mole histology prior to GTN, presence of metastatic disease, use of multi-agent therapy and higher FIGO score were independent factors associated with longer time to hCG remission in low-risk GTN. Identifying the prognostic factors associated with time to remission and effective counseling may help improve treatment planning and reduce anxiety in patients and their families.
authors.affiliation: Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP-Sao Paulo State University, Botucatu, SP, Brazil.
authors.forename: Izildinha
authors.initials: I
authors.lastname: Maestá
authors.forename: Whitfield B
authors.initials: WB
authors.lastname: Growdon
authors.forename: Donald P
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Marilyn R
authors.initials: MR
authors.lastname: Bernstein
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
authors.forename: Marilza Vieira Cunha
authors.initials: MV
authors.lastname: Rudge
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D006063:Chorionic Gonadotropin / Q000097:blood*; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000097:blood / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011379:Prognosis; D012306:Risk; D013997:Time Factors
chemical_list: D006063:Chorionic Gonadotropin
keywords: Chemotherapy; Low-risk gestational trophoblastic neoplasia; Prognostic factors; hCG remission