[Management and prognosis in stage IV gestational trophoblastic neoplasia patients].

Objective: To analyze the management and prognosis in stage IV gestational trophoblastic neoplasia (GTN) patients.

Methods: One thousand one hundred and thirty GTN patients were hospitalized and treated at Peking Union Medical College Hospital from year 1985 to 2004. Ninety-two of them were diagnosed as stage IV of GTN. Retrospective analyses were carried out on these patients in terms of management and prognosis.

Results: Of the 92 patients who had undergone treatment, complete remission (CR) was achieved in 33, partial remission in 37, and progress of the disease was seen in 22. Among all the CR patients, three had recurrence later. Thirty-three out of all the patients died during or after treatment. Among the 92 cases, 70 had one or two metastases, of whom 27 had CR, and 20 died. Of the 17 cases who had three metastases, 5 achieved CR, and 10 died. Of the five cases with >or= 4 metastases, one had CR, and three died. The number of metastatic organs was correlated with prognosis (P = 0.034) and death (P = 0.018).

Conclusions: Multi-drug and multi-route chemotherapy and (or) combined surgical intervention may improve the survival rate of the stage IV GTN patients. The management should be individualized for different patients with metastases. With the increase in the number of metastatic organs, the remission rate decreases.