Gestational trophoblastic neoplasia: treatment outcomes.

OBJECTIVE: To report the results of treatment of gestational trophoblastic neoplasia (GTN) at the John I. Brewer Trophoblastic Disease Center over the past 28 years, compare the outcomes to those from the first 16 years, and analyze factors affecting response to treatment and survival. METHODS: We reviewed the records of 408 patients with GTN (excluding placental-site tumors) treated at the Brewer Center from 1979 to 2006. Outcomes and prognostic factors were analyzed and compared with those for the 396 patients treated at the Brewer Center from 1962 to 1978. RESULTS: The overall survival rate in 804 patients with GTN treated from 1962 to 2006 was 93.3% (88.6% from 1962 to 1978 and 97.8% from 1979 to 2006). All 491 patients with nonmetastatic disease treated during both time periods were cured; however, the cure rate for patients with metastatic disease increased from 77.8% (158 of 203) during 1962-1978 to 91.8% (101 of 110) during 1979-2006. Factors determined to significantly influence resistance to initial chemotherapeutic treatment on multivariable analysis from 1979 to 2006 were 1) presence of metastatic compared with nonmetastatic disease (41% compared with 12%; odds ratio [OR] 0.21, 95% confidence interval [CI] 0.13-0.35); 2) metastatic site other than the lung or vagina (76% compared with 31%; OR 0.05, 95% CI 0.02-0.13); 3) prior unsuccessful chemotherapy at another institution compared with primary treatment at our center (63% compared with 17%; OR 0.11, 95% CI 0.05-0.22); and 4) duration of disease greater than 4 months compared with 4 months or less (35% compared with 17%; OR 0.38, 95% CI 0.21-0.66). CONCLUSION: The overall survival rate in patients with GTN treated at the Brewer Center improved from 88.6% in 1962-1978 to 97.8% in 1979-2006.