Relationship between race and clinical characteristics, extent of disease, and response to chemotherapy in patients with low-risk gestational trophoblastic neoplasia.
OBJECTIVE
To evaluate the potential effects of race on clinical characteristics, extent of disease, and response to chemotherapy in women with postmolar low-risk gestational trophoblastic neoplasia (GTN).


METHODS
This non-concurrent cohort study was undertaken including patients with FIGO-defined postmolar low-risk GTN treated with comparable doses and schedules of chemotherapy at the New England Trophoblastic Disease Center (NETDC) between 1973 and 2012. Racial groups investigated included whites, African American and Asians. Information on patient characteristics and response to chemotherapy (need for second line chemotherapy, reason for changing to an alternative chemotherapy, number of cycles/regimens, need for combination chemotherapy, and time to hCG remission) was obtained.


RESULTS
Of 316 women, 274 (86.7%) were white, 19 (6%) African American, and 23 (7.3%) Asian. African Americans were significantly younger than white and Asian women (p=0.008). Disease presentation, and extent of disease, including antecedent molar histology, median time to persistence, median hCG level at persistence, rate of D&C at persistence, presence of metastatic disease, and FIGO stage and risk score were similar among races. Need for second line chemotherapy (p=0.023), and median number of regimens (p=0.035) were greater in Asian women than in other races.


CONCLUSIONS
Low-risk GTN was more aggressive in Asian women, who were significantly more likely to need second line chemotherapy and a higher number of chemotherapy regimens to achieve complete remission than women of African American and Asian descent. Further studies involving racial differences related to clinical, biological and environmental characteristics are needed.
Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP-Sao Paulo State University, Botucatu, SP, Brazil; Trophoblastic Diseases Center of the Botucatu Medical School, UNESP-Sao Paulo State University, Botucatu, SP, Brazil. Electronic address: imaesta@fmb.unesp.br.
Izildinha
I
Maestá
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein M.D. Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA.
Ross S
RS
Berkowitz
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein M.D. Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA.
Donald P
DP
Goldstein
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein M.D. Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA.
Marilyn R
MR
Bernstein
Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP-Sao Paulo State University, Botucatu, SP, Brazil; Clinical Department, Caldas University, Manizales, Caldas, Colombia.
Luz Angela C
LA
Ramírez
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein M.D. Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA.
Neil S
NS
Horowitz
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001213:Asian; D006063:Chorionic Gonadotropin / Q000378:metabolism; D003520:Cyclophosphamide / Q000008:administration & dosage; D003609:Dactinomycin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy* / Q000208:ethnology* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009367:Neoplasm Staging; D011247:Pregnancy; D012307:Risk Factors; D044465:White People; D055815:Young Adult
D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D005047:Etoposide; D003520:Cyclophosphamide; D005492:Folic Acid; D008727:Methotrexate
Low-risk gestational trophoblastic neoplasia; Racial disparities; Response to chemotherapy