Efficacy And Prognosis Of Gestational Trophoblastic Tumors: A Retrospective Cohort Study Of Newly Diagnosed Patients In Peking Union Medical College Hospital

Objectives:To analyze and compare the remission rate of gestational trophoblastic neoplasia(GTN)patients initially treated at Peking Union Medical College Hospital(PUMCH)from 1985-2015 retrospectively.At the same time,evaluate the prognostic risk factors of the GTN patients.Methods and Materials:Between January 1985 and December 2015,1711 patients diagnosed with GTN were initially treated at PUMCH.There are 545 patients diagnosed between 1985 and 2001,the other 1166 are identified between 2002 and 2015.The diagnoses,stages,scores according to the FIGO 2000 of all the patients were analyzed respectively.Multivariate analysis of Cox regression was carried out to evaluate the prognostic risk factors and their hazard ratio(HR).Results:1.The complete remission(CR)rate of all cases was 96.3%(1648/1711),the CR rates of the GTN patients from 1985-2001 and 2002-2015 were 93.6%(510/545)and 97.6%(1138/1166),respectively,P<0.001.2.The mortality of all the patients is 2.57%(44/1711).Among all the CR patients,2.71%(45/1663)cases relapsed later.3.The CR rate of the patients diagnosed with invasive mole(IM)was 98.5%(1012/1027);in the patients diagnosed with choriocarcinoma(CC)the CR rate is 93.0%(636/684),which is lower than IM,HR=4.884(95%CI:2.735-8.721),P<0.001.The CR rate of the patients in 2002-2015 diagnosed with no matter IM or CC were significantly higher than that of 1985-2001.4.Totally 511 cases of stage ?(29.9%),57 cases of stage ?(3.3%),1048 cases of stage ?(61.3%),95 cases of stage IV(5.6%)were analyzed.The percentage of the cases with stage ?,?,? in group 2002-2015 were smaller than group 1985-2001.The prognoses of stage IV patients were the worst,but were better in 2002-2015 group(76.5%)than in the 1985-2001 group(59.1%),P<0.001.5.The cure rate of the high risk(score?7)group was 86.9%(306/352),which is significantly lower than that of the low risk(score 0-6)group(98.7%,1342/1359),HR=11.092(95%CI:6.357-19.353).6.Multivariate Cox analysis confirmed that age(>40y or not),antecedent pregnancy(hydatidiform mole or not)and site of metastases(distant metastases except lung)were independent prognosis factors.While the interval from antecedent pregnancy to chemotherapy,pre-treatment serum hCG,largest tumor mass diameter and number of metastases were significant prognostic determinants on univariate analysis but turn not significant on multivariate analysis.Conclusion:Patients diagnosed with GTN can achieve satisfactory curative effects if they can receive standard and promptly chemotherapy treatment.There is an improvement of the CR rate in recent tens of years.Some risk factors in FIGO(2000)might not be the independent risk factors of prognosis.Further work is urgently needed to validate these prognostic factors.