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Gynecol Oncol. 2013 Aug;130(2):312-6. doi: 10.1016/j.ygyno.2013.05.017. Epub 2013 May 23.

Prognostic factors associated with time to hCG remission in patients with low-risk postmolar gestational trophoblastic neoplasia.

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1
Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP-Sao Paulo State University, Botucatu, SP, Brazil.

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.

KEYWORDS:

Chemotherapy; Low-risk gestational trophoblastic neoplasia; Prognostic factors; hCG remission

PMID:
23707672
DOI:
10.1016/j.ygyno.2013.05.017
[Indexed for MEDLINE]

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