title: The influence of lung metastases on the clinical course of gestational trophoblastic neoplasia: a historical cohort study.
abstract: OBJECTIVE
  To evaluate whether gestational trophoblastic neoplasia (GTN) patients with lung metastases have more adverse outcomes such as resistance to chemotherapy, recurrence or death of disease compared with patients without lung metastases.
  
  
  METHODS
  Historical observational cohort study.
  
  
  METHODS
  The Netherlands.
  
  
  METHODS
  We identified 434 GTN patients (72 patients with lung metastases, 362 patients without metastases) between 1990 and 2012 registered in the Dutch national databases.
  
  
  METHODS
  Baseline characteristics, recurrence rates, Methotrexate (MTX) remission rates and deaths from disease were compared between patients with lung metastases (group I) and without lung metastases (group II) using the Fisher exact test or Mann-Whitney U-test where applicable.
  
  
  METHODS
  Methotrexate resistance, recurrences and survival.
  
  
  RESULTS
  Methotrexate resistance did not differ between group I and group II (62.9 versus 72.7% P = 0.19). However, the observed recurrence rate was significantly increased in patients with lung metastases compared with patients without metastases (16.7 versus 2.2% P < 0.0001), also after correction for antecedent pregnancy and interval (from the end of the antecedent pregnancy until the start of treatment). Disease-specific survival was 91.7% in the group with lung metastases and 100% in the patients without metastases (P < 0.0001).
  
  
  CONCLUSIONS
  Although lung metastases are considered to be associated with a low risk of adverse outcomes, their presence appears to increase the risk for recurrence and death of disease. Further research is needed to evaluate whether the presence of lung metastases is an independent risk factor that needs adjustment in the FIGO scoring system and clinical classification system.
  
  
  CONCLUSIONS
  In gestational trophoblastic neoplasia (GTN) recurrence is more often observed in the case of lung metastases.
authors.affiliation: Department of Gynaecologic Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Vree
authors.affiliation: Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: van Trommel
authors.affiliation: Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Kenter
authors.affiliation: Department of Laboratory Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Sweep
authors.affiliation: Department of Gynaecologic Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ten Kate-Booij
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Massuger
authors.affiliation: Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands. c.lok@nki.nl.
authors.forename: C
authors.initials: C
authors.lastname: Lok
mesh_terms: D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D015331:Cohort Studies; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods / Q000401:mortality; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary; D008727:Methotrexate / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009426:Netherlands; D011247:Pregnancy; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate
keywords: Gestational trophoblastic disease; gestational trophoblastic neoplasia; lung metastases; methotrexate; recurrence