Clinicopathological characteristics and oncologic outcomes of patients with gestational trophoblastic neoplasia manifesting as isolated pulmonary lesions.

Gynecol Oncol

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; National Clinical Research Center for Obstetric & Gynecologic Diseases, China. Electronic address:

Published: November 2024

AI Article Synopsis

  • The study investigates the characteristics and treatment outcomes of patients with gestational trophoblastic neoplasia (GTN) who initially present with lung lesions and high hCG levels but without visible pelvic lesions.
  • The analysis included 40 patients from a larger group of 2358, revealing that most had solitary lung tumors, primarily epithelioid trophoblastic tumors (ETT), and those treated with only chemotherapy faced higher recurrence rates.
  • It concludes that surgical removal of lung lesions is critical, and if chemotherapy is used, it should involve a multidrug approach to reduce the risk of relapse.

Article Abstract

Objective: To elucidate the clinicopathological characteristics and oncological outcomes of a special group of patients with gestational trophoblastic neoplasia (GTN) initially presenting with isolated lung lesions, elevated human chorionic gonadotropin (hCG) levels, and unobserved pelvic lesions.

Methods: Overall, 2358 patients with GTN treated at our hospital between 2000 and 2023 were retrospectively reviewed, and 40 patients were evaluated. The demographic characteristics, clinicopathological features, treatment data, and follow-up information of each patient were collected. The primary outcome was progression free survival. Kaplan-Meier analysis and univariate and multivariate Cox proportional hazard analyses were used to identify the risk factors.

Results: Among the 40 patients, 95.0 % had solitary lung lesions, with a median size of 1.9 cm. Moreover, 72.5 % of patients were pathologically confirmed as epithelioid trophoblastic tumors (ETT). During a median follow-up period of 53.5 months (range, 2-143), 11 patients experienced recurrence, including all patients who received chemotherapy alone as the initial treatment, and no death was observed. Relapse treatment involved lung segmentectomy and lobectomy combined with chemotherapy and immunotherapy. Univariate and multivariate Cox analyses identified comparing with surgery±chemotherapy, chemotherapy alone as the initial treatment (hazard ratio [HR] =7.738, 95 % confidence interval [CI] 1.698-35.269, P = 0.008) as independent risk factor for recurrence.

Conclusions: In patients with a history of pregnancy exhibiting isolated pulmonary lesions, elevated hCG levels (mostly <1000 mIU/mL), and unobserved pelvic lesions, ETT should be considered first. Surgical resection of lung lesion is crucial for optimal management. When chemotherapy is considered, multidrug regimen is recommended.

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Source
http://dx.doi.org/10.1016/j.ygyno.2024.07.686DOI Listing

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