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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(08): 746-754
DOI: 10.1055/s-0042-1748974
Original Article
Gestational Trophoblastic Neoplasia

Clinical Presentation, Treatment Outcomes, and Resistance-related Factors in South American Women with Low-risk Postmolar Gestational Trophoblastic Neoplasia

Apresentação clínica, resultados do tratamento e fatores relacionados à resistência em mulheres sul-americanas com neoplasia trofoblástica gestacional pós-molar de baixo risco
Luz Angela Correa Ramírez 
1   Postgraduation Program in Tocogynecology of Botucatu Medical School, São Paulo State University Julio de Mesquita Filho - UNESP, Support Program for Foreign Doctoral Students (PAEDEx/UNESP) Botucatu, SP, Brazil
2   Clinical Department, Universidad de Caldas, Manizales, Caldas, Colombia
,
Izildinha Maestá 
3   Botucatu Trophoblastic Disease Center of the Clinical Hospital of Botucatu Medical School, Department of Gynecology and Obstetrics, São Paulo State University Julio de Mesquita Filho - UNESP, Botucatu, SP, Brazil
,
María Inés Bianconi 
4   Carlos G Durand Hospital Trophoblastic Disease Center, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
,
Gustavo Jankilevich 
4   Carlos G Durand Hospital Trophoblastic Disease Center, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
,
Silvina Otero 
4   Carlos G Durand Hospital Trophoblastic Disease Center, Faculty of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
,
Carlos Raúl Villegas Mejía 
5   Oncólogos del Occidente S.A. Manizales, Caldas, Colombia
,
Rafael Cortés-Charry 
6   Department of Obstetrics and Gynecology, Hospital Universitario de Caracas, Universidad Central de Venezuela, Caracas, Venezuela
,
Kevin M. Elias 
7   Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, New England Trophoblastic Disease Centre, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Neil S. Horowitz 
7   Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, New England Trophoblastic Disease Centre, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Michael Seckl 
8   Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
,
Ross S. Berkowitz 
7   Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, New England Trophoblastic Disease Centre, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Abstract

Objective There are few multinational studies on gestational trophoblastic neoplasia (GTN) treatment outcomes in South America. The purpose of this study was to assess the clinical presentation, treatment outcomes, and factors associated with chemoresistance in low-risk postmolar GTN treated with first-line single-agent chemotherapy in three South American centers.

Methods Multicentric, historical cohort study including women with International Federation of Gynecology and Obstetrics (FIGO)-staged low-risk postmolar GTN attending centers in Argentina, Brazil, and Colombia between 1990 and 2014. Data were obtained on patient characteristics, disease presentation, and treatment response. Logistic regression was used to assess the relationship between clinical factors and resistance to first-line single-agent treatment. A multivariate analysis of the clinical factors significant in univariate analysis was performed.

Results A total of 163 women with low-risk GTN were included in the analysis. The overall rate of complete response to first-line chemotherapy was 80% (130/163). The rates of complete response to methotrexate or actinomycin-D as first-line treatment, and actinomycin-D as second-line treatment postmethotrexate failure were 79% (125/157), 83% (⅚), and 70% (23/33), respectively. Switching to second-line treatment due to chemoresistance occurred in 20.2% of cases (33/163). The multivariate analysis demonstrated that patients with a 5 to 6 FIGO risk score were 4.2-fold more likely to develop resistance to first-line single-agent treatment (p = 0.019).

Conclusion 1) At presentation, most women showed clinical characteristics favorable to a good outcome, 2) the overall rate of sustained complete remission after first-line single-agent treatment was comparable to that observed in developed countries, 3) a FIGO risk score of 5 or 6 is associated with development of resistance to first-line single-agent chemotherapy.

Resumo

Objetivo Existem poucos estudos multinacionais sobre os resultados do tratamento da neoplasia trofoblástica gestacional (NTG) na América do Sul. O objetivo deste estudo foi avaliar a apresentação clínica, os resultados do tratamento e os fatores associados a casos de quimiorresistência em NTG pós-molar de baixo risco tratados com quimioterapia de agente único de primeira linha em três centros sul-americanos.

Métodos Estudo multicêntrico de coorte histórica incluindo mulheres com NTG pós-molar de baixo risco com estadiamento International Federation of Gynecology and Obstetrics (FIGO) em centros de atendimento na Argentina, Brasil e Colômbia entre 1990 e 2014. Foram obtidos dados sobre as características do paciente, apresentação da doença e resposta ao tratamento. A regressão logística foi usada para avaliar a relação entre fatores clínicos e resistência ao tratamento de primeira linha com agente único. Foi realizada uma análise multivariada dos fatores clínicos significativos na análise univariada.

Resultados Cento e sessenta e três mulheres com NTG de baixo risco foram incluídas na análise. A taxa global de resposta completa à quimioterapia de primeira linha foi de 80% (130/163). As taxas de resposta completa ao metotrexato ou actinomicina-D como tratamento de primeira linha e actinomicina-D como tratamento de segunda linha após falha do metotrexato foram 79% (125/157), 83% (⅚) e 70% (23/33), respectivamente. A mudança para o tratamento de segunda linha por quimiorresistência ocorreu em 20,2% dos casos (33/163). A análise multivariada demonstrou que pacientes com pontuação de risco FIGO de 5 a 6 foram 4,2 vezes mais propensos a desenvolver resistência ao tratamento com agente único de primeira linha (p = 0,019).

Conclusão 1) Na apresentação, a maioria das mulheres demonstrou características clínicas favoráveis a um bom resultado, 2) a taxa geral de remissão completa sustentada após o tratamento de primeira linha com agente único foi comparável à de países desenvolvidos, 3) um escore de risco FIGO de 5 ou 6 está associado ao desenvolvimento de resistência à quimioterapia de agente único de primeira linha.

Keywords

low-risk gestational trophoblastic neoplasia - molar pregnancy - South America - chemotherapy - resistance-related factors

Palavras-chave

neoplasia trofoblástica gestacional de baixo risco - gravidez molar - América do Sul - quimioterapia - fatores relacionados à resistência

Contributions

L. A. C. R. conceived and designed the study, reviewed the literature, and collected and managed data from the databases of Durand Trophoblastic Disease Center in Buenos Aires (Carlos G. Durand Hospital), Botucatu Trophoblastic Disease Center (São Paulo State University), and Oncólogos del Occidente S.A. Manizales, Caldas, Colombia; wrote the initial draft of the manuscript. I. M. conceived and designed the study, wrote the manuscript and audited data collected from Botucatu Trophoblastic Disease Center database (São Paulo State University) by L. A. C. R. M. I. B. audited the data collected by L. A. C. R. from the Durand Trophoblastic Disease Center database in Buenos Aires (Carlos G. Durand Hospital) and contributed to data analysis. G. J. helped analyzing data from the Durand Trophoblastic Disease Center database in Buenos Aires (Carlos G. Durand Hospital) and contributed to the manuscript. S. O. helped with the analysis of data from the Carlos G. Durand Hospital database and contributed to the manuscript. C. R. V. M. audited data collected by L. A. C. R. from the database of Oncólogos del Occidente S.A. Manizales, Caldas, Colombia and contributed to the manuscript. R. C. C. contributed to data analysis and interpretation and reviewed the literature for discussion. K. M. E. conceived the analysis strategy and contributed to the manuscript. N. S. H. contributed to data analysis and interpretation and revised the manuscript. M. J. S. supervised the study and revised the manuscript. R. S. B. supervised the study and revised the manuscript.




Publication History

Received: 03 February 2022

Accepted: 28 March 2022

Article published online:
27 June 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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