Diagnosis, Treatment and Outcomes of Gestational Trophoblastic Neoplasia in a Low Resource Income Country

Gueye, Mamour; Ndiaye-Gueye, Mame Diarra; Kane-Guèye, Serigne Modou; Gassama, Omar; Diallo, Moussa; Moreau, Jean Charles

doi:10.21106/ijma.108

Cited by 7 publications

(3 citation statements)

References 10 publications

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“…A total of 60 studies met all inclusion criteria, 25 of which were excluded for suspected overlapping patient data, reported from the same or overlapping institutions in overlapping time periods (Table S1). Ultimately, 35 studies were included 25‐59 (see Figure S1 for PRISMA flow diagram of study selection).…”

Section: Resultsmentioning

confidence: 99%

Treatments and outcomes in high‐risk gestational trophoblastic neoplasia: A systematic review and meta‐analysis

Albright

Ellett

Knochenhaur

et al. 2023

BJOG

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Background: High-risk gestational trophoblastic neoplasia (GTN) is rare and treated with diverse approaches. Limited published institutional data has yet to be systematically reviewed. Objectives: To compile global high-risk GTN (prognostic score ≥7) cohorts to summarise treatments and outcomes by disease characteristics and primary chemotherapy. Search Strategy: MEDLINE, Embase, Scopus, ClinicalTrials.gov and Cochrane were searched through March 2021. Selection Criteria: Full-text manuscripts reporting mortality among ≥10 high-risk GTN patients. Data Collection and Analysis: Binomial proportions were summed, and randomeffects meta-analyses performed. Main Results: From 1137 records, we included 35 studies, representing 20 countries. Among 2276 unique high-risk GTN patients, 99.7% received chemotherapy, 35.8% surgery and 4.9% radiation. Mortality was 10.9% (243/2236; meta-analysis: 10%, 95% confidence interval [CI] 7-12%) and likelihood of complete response to primary chemotherapy was 79.7% (1506/1890; meta-analysis: 78%, 95% CI: 74-83%). Across 24 reporting studies, modern preferred chemotherapy (EMA/CO or EMA/EP) was associated with lower mortality (overall: 8.8 versus 9.5%; comparative meta-analysis: 8.1 versus 12.4%, OR 0.42, 95% CI: 0.20-0.90%, 14 studies) and higher likelihood of complete response (overall: 76.6 versus 72.8%; comparative meta-analysis: 75.9 versus 60.7%, OR 2.98, 95% CI: 1.06-8.35%, 14 studies), though studies focused on non-preferred regimens reported comparable outcomes. Mortality was increased for ultra-high-risk disease (30 versus 7.5% high-risk; meta-analysis OR 7.44, 95% CI: 4.29-12.9%) and disease following term delivery (20.8 versus 7.3% following molar pregnancy; meta-analysis OR 2.64, 95% CI: 1.10-6.31%). Relapse rate estimates ranged from 3 to 6%. Conclusions: High-risk GTN is responsive to several chemotherapy regimens, with EMA/CO or EMA/EP associated with improved outcomes. Mortality is increased in patients with ultra-high-risk, relapsed and post-term pregnancy disease.

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Section: Resultsmentioning

confidence: 99%

Treatments and outcomes in high‐risk gestational trophoblastic neoplasia: A systematic review and meta‐analysis

Albright

Ellett

Knochenhaur

et al. 2023

BJOG

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“…El Acetato de Medroxiprogesterona es una opción para las mujeres que tienen dificultad para cumplir con el uso de anticonceptivos orales. Un dispositivo intrauterino no debe ser utilizado antes de que la BHCG se normalice debido al riesgo de perforación uterina por la subinvolución del útero o mola invasiva [1,8,9].En casos en que la medición de BHCG no disminuya > 10 % por 3 semanas o que persista niveles elevados por más de 6 meses se considera patología trofoblástica persistente, ameritando recibir quimioterapia a base de Metotrexate [9,11], en el caso citado el descenso de BHCG fue importante después del procedimiento con un valor de 25000 mUI/ml, a los 4 meses el valor de BHCG fue <1 mUI/ml por lo cual se decidió el alta definitiva.…”

Section: Discussionunclassified

Caso Clínico: Mola Hidatiforme Parcial. Resolución Obstétrica

Cárdenas¹,

Beltrán²,

Ocampo³

2017

Rev. Méd. HJCA

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“…Higher GTD frequencies have been reported from Asia, the Middle East, and Africa. Although GTD reference centres exist [12][13][14][15] (South Korea, China, Senegal), the development of registries or opening of further reference centres may help with more accurate data collection. Recent reports from South Korea [1] and from the Chiba prefecture in Japan [16] document a similar molar pregnancy incidence as that in Europe or the USA.…”

Section: Reference Centres For Trophoblastic Diseasesmentioning

confidence: 99%

Expert Pathology for Gestational Trophoblastic Disease: Towards an International Multidisciplinary Team Meeting

Kaur,

Nadal,

Bartosch

et al. 2024

Gynecol Obstet Invest

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Background: Gestational trophoblastic disease, comprising hydatidiform moles and gestational trophoblastic tumours, is extremely rare. Exact diagnosis is crucial to indicate the appropriate treatment and to prevent complications. The scarcity and variability in the number of cases available for reporting, lack of specialized training in GTD and non-existence of refresher courses available implies that the pathologist dealing with these rare and at times extremely challenging cases are not completely confident in their diagnosis. Objectives: To explores the benefits of implementation of an international multidisciplinary conference (virtual) to aid diagnosis of difficult cases and support clinical management of GTD. Methods: A short survey was circulated to all 46 members of the EOTTD pathology and genetics working party, and further spread to other colleagues who practice GTD. This showed that the pathologists and geneticists working with GTD patients do not feel adequately supported and equipped with dealing with these rare diseases. Outcome: Virtual cross-border MDTs were initiated in April 2022, bringing together participants from 11 European countries on a bi-yearly basis. Mean numbers of 3 patients are discussed during the MDTs followed by 3-4 QA cases. A participant survey was conducted at the end of virtual meeting with an average satisfaction rate of 9.5. The pathologists felt supported and benefited from networking and clinical collaboration. Conclusions and Outlook: This international multidisciplinary team meeting (MDT) continues to provide support in managing the uncertainty with difficult and rare cases and enhances the pathologists training and experience. The frequency of meetings and the number of cases discussed per meeting will be increased in 2023 given the positive response. This will empower individuals and organisations to work together and improve diagnosis and the prognosis for these young patients.

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Diagnosis, Treatment and Outcomes of Gestational Trophoblastic Neoplasia in a Low Resource Income Country

Cited by 7 publications

References 10 publications

Treatments and outcomes in high‐risk gestational trophoblastic neoplasia: A systematic review and meta‐analysis

Treatments and outcomes in high‐risk gestational trophoblastic neoplasia: A systematic review and meta‐analysis

Caso Clínico: Mola Hidatiforme Parcial. Resolución Obstétrica

Expert Pathology for Gestational Trophoblastic Disease: Towards an International Multidisciplinary Team Meeting

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