Persistence and malignant sequelae of gestational trophoblastic disease: Clinical presentation, diagnosis, treatment and outcome

Khoo, SK, Sidhu, M, Baartz, D, Yip, WL and Tripcony, L (2010) Persistence and malignant sequelae of gestational trophoblastic disease: Clinical presentation, diagnosis, treatment and outcome. Australian & New Zealand Journal of Obstetrics and Gynaecology, 50 1: 81-86. doi:10.1111/j.1479-828X.2009.01114.x


Author Khoo, SK
Sidhu, M
Baartz, D
Yip, WL
Tripcony, L
Title Persistence and malignant sequelae of gestational trophoblastic disease: Clinical presentation, diagnosis, treatment and outcome
Journal name Australian & New Zealand Journal of Obstetrics and Gynaecology   Check publisher's open access policy
ISSN 0004-8666
Publication date 2010-02-01
Year available 2010
Sub-type Article (original research)
DOI 10.1111/j.1479-828X.2009.01114.x
Volume 50
Issue 1
Start page 81
End page 86
Total pages 6
Editor David Ellwood
Place of publication Australia
Publisher Wiley-Blackwell Publishing Asia
Collection year 2011
Language eng
Subject C1
9201 Clinical Health (Organs, Diseases and Abnormal Conditions)
11 Medical and Health Sciences
1103 Clinical Sciences
Abstract Background: The major concern in gestational trophoblastic disease is management of persistent disease and malignant sequelae. However, prediction of response to treatment is difficult and methods used controversial. Aim and methods: To evaluate the usefulness of clinical presentation, methods of diagnosis and categorisation of risk in determining clinical outcomes, by analysis of a database of 705 registered patients collected over 30 years. Results: From the database, there were 97 patients who developed persistent disease and malignant sequelae on the basis of defined criteria – 80.4% had molar pregnancy and 19.6% non-molar pregnancy. Vaginal bleeding was not a common presentation; 59.8% had no clinical symptoms. According to protocol, monitoring by serial human chorion gonadotrophin (HCG) levels followed by imaging screen was used in all patients; histology was also available in 41.2% from hysterectomy and curettage specimens. There were 16 of 76 patients with persisting disease who had metastases (21.1%), and 2 of 20 patients with choriocarcinoma who had an antecedent molar pregnancy (10.0%). Based on five risk factors, 25 patients were categorised as 'high risk' and assigned to receive multi-drug chemotherapy. There were two deaths (2.1% for all malignant sequelae); both were from molar pregnancies. One patient failed to respond and the other suffered a complication of intensive chemotherapy. Conclusion: Serial HCG levels remain the best monitor to determine therapeutic response. Categorisation of 'high risk' by five factors is useful in treatment. Albeit a small series, clinical outcome is favourable with a five-year survival of 89.7%.
Keyword outcome
persistent disease and malignant trophoblastic disease
risk factors
COMPLETE MOLAR PREGNANCY
HYDATIDIFORM MOLE
HCG LEVELS
NEOPLASIA
RISK
CHORIOCARCINOMA
CLASSIFICATION
MANAGEMENT
8P12-P21
WOMEN
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 28 Feb 2010, 10:07:04 EST