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Prognostic Factors Associated with hCG Remission and Chemotherapy Resistance in Patients with High-Risk Gestational Trophoblastic Neoplasia

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Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Objective

The main aim of this study was to assess the effect of various clinical factors on time to hCG remission and chemoresistance among women with high-risk gestational trophoblastic neoplasia (GTN).

Methods

This retrospective study compromised of 63 patients diagnosed with high-risk GTN. Associations of time to hCG remission with type of previous gestation, parity, presence of metastatic disease, FIGO score, hCG values at diagnosis and need for further lines of chemotherapy were investigated using odds ratio. Associations of chemoresistance with above clinical variables were analysed using chi-square test.

Results

Median cycles and time to remission were 5 cycles and 87 days, respectively. The analysis showed that FIGO score > 10 (p = 0.0081), presence of metastatic disease (p = 0.037), stage 4 disease and need for second line multiagent therapy (p = 0.007) were associated with significantly increased days to remission. Although hCG ≥ 105 mIU/mL at diagnosis had higher days to remission compared to a hCG levels < 105, it was not statistically significant (p = 0.089). There was a linear increase in time to hCG remission by 7 days with every point increment in FIGO score. Presence of metastasis, stage 4 disease, FIGO score > 10 and pre-treatment serum hCG > 100,000 mIU/mL was significantly associated with the risk of resistance to first line chemotherapy.

Conclusions

Our results show that presence FIGO score > 10, metastatic disease, stage 4 disease and use of second line therapy were associated with longer time to hCG remission in high-risk GTN. Presence of metastasis, FIGO score > 10 and pre-treatment serum hCG > 100,000 mIU/mL is associated with the risk of chemoresistance. Early identification of resistance and change of chemotherapy so as to minimize the exposure of these patients to ineffective chemotherapy and hence decrease the duration of chemotherapy and its associated morbidity.

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Authors and Affiliations

  1. Department of Gynaecological oncology, Kidwai Memorial Institute of Oncology, Bangalore, 560029, India

    S. V. Tejas, V. R. Pallavi, K. Shobha & S. K. Rajshekhar

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  1. S. V. Tejas
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  2. V. R. Pallavi
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  3. K. Shobha
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  4. S. K. Rajshekhar
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Correspondence to V. R. Pallavi.

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Tejas, S.V., Pallavi, V.R., Shobha, K. et al. Prognostic Factors Associated with hCG Remission and Chemotherapy Resistance in Patients with High-Risk Gestational Trophoblastic Neoplasia. Indian J Gynecol Oncolog 20, 52 (2022). https://doi.org/10.1007/s40944-022-00659-4

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