Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
Background Placental-site trophoblastic (PSTT) and epithelioid trophoblastic tumours (ETT) are the rarest malignant forms of gestational trophoblastic disease (GTD). Our prior work demonstrated that an interval of ≥48 months from the antecedent pregnancy was associated with 100% death rate, independ...
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| Veröffentlicht in: | British journal of cancer 2019-03, Vol.120 (6), p.587-594 |
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| creator | Froeling, Fieke E. M. Ramaswami, Ramya Papanastasopoulos, Panagiotis Kaur, Baljeet Sebire, Neil J. Short, Dee Fisher, Rosemary A. Sarwar, Naveed Wells, Michael Singh, Kam Ellis, Laura Horsman, Janet M. Winter, Matthew C. Tidy, John Hancock, Barry W. Seckl, Michael J. |
| description | Background
Placental-site trophoblastic (PSTT) and epithelioid trophoblastic tumours (ETT) are the rarest malignant forms of gestational trophoblastic disease (GTD). Our prior work demonstrated that an interval of ≥48 months from the antecedent pregnancy was associated with 100% death rate, independent of the stage. Here, we assess whether modified treatments for these patients have increased survival and identify new prognostic factors.
Methods
The United Kingdom GTD database was screened to identify all PSTT/ETT cases diagnosed between 1973 and 2014. Data and survival outcomes from our prior patient cohort (1976–2006) were compared to our new modern cohort (2007–2014), when intensified treatments were introduced.
Results
Of 54,743 GTD patients, 125 (0.23%) were diagnosed with PSTT and/or ETT. Probability of survival at 5 and 10 years following treatment was 80% (95% CI 72.8–87.6%) and 75% (95% CI 66.3–84.3%), respectively. Univariate analysis identified five prognostic factors for reduced overall survival (age, FIGO stage, time since antecedent pregnancy, hCG level, mitotic index) of which stage IV disease (HR 6.18, 95% CI 1.61–23.81,
p
= 0.008) and interval ≥48 months since antecedent pregnancy (HR 14.57, 95% CI 4.17–50.96,
p
|
| doi_str_mv | 10.1038/s41416-019-0402-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6461960</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2185566099</sourcerecordid><originalsourceid>FETCH-LOGICAL-c470t-59a166182f8bf4f3976d0fa5e3b8b4ef87dfbe9cf506b2bdac95d51db2124e103</originalsourceid><addsrcrecordid>eNp1kU-L1TAUxYMoznP0A7iRgJvZVG_SNm02ggyODgy40XVI25v3MqRJTdIHfgk_s-m8cfwDrkLI7557Tg4hLxm8YVD3b1PDGiYqYLKCBngFj8iOtTWvWM-7x2QHAF0FksMZeZbSbblK6Lun5KyGTvK2hh35ce0z-mSNxYnmA0a9WEzUzksMR6RpjUd71I5qP1E7oc-FHHW2wdNgqC-MowXd-5CyHanRYw4xURMiXZwey4B2VbIZ7xRwsWWHs8GWZTEshzA4fTeY1zmsMT0nT4x2CV_cn-fk69WHL5efqpvPH68v399UY9NBrlqpmRAlpekH05hadmICo1ush35o0PTdZAaUo2lBDHyY9CjbqWXTwBlvsPzdOXl30l3WYcZp8xm1U0u0s47fVdBW_f3i7UHtw1GJRjApNoGLe4EYvq2YspptGtE57TGsSXHWt60QIGVBX_-D3paovsQrlGwYr4urQrETNcaQUkTzYIaB2tpWp7ZVaVttbavNxKs_UzxM_Kq3APwEpPLk9xh_r_6_6k-0K7q8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2194123212</pqid></control><display><type>article</type><title>Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><creator>Froeling, Fieke E. M. ; Ramaswami, Ramya ; Papanastasopoulos, Panagiotis ; Kaur, Baljeet ; Sebire, Neil J. ; Short, Dee ; Fisher, Rosemary A. ; Sarwar, Naveed ; Wells, Michael ; Singh, Kam ; Ellis, Laura ; Horsman, Janet M. ; Winter, Matthew C. ; Tidy, John ; Hancock, Barry W. ; Seckl, Michael J.</creator><creatorcontrib>Froeling, Fieke E. M. ; Ramaswami, Ramya ; Papanastasopoulos, Panagiotis ; Kaur, Baljeet ; Sebire, Neil J. ; Short, Dee ; Fisher, Rosemary A. ; Sarwar, Naveed ; Wells, Michael ; Singh, Kam ; Ellis, Laura ; Horsman, Janet M. ; Winter, Matthew C. ; Tidy, John ; Hancock, Barry W. ; Seckl, Michael J.</creatorcontrib><description>Background
Placental-site trophoblastic (PSTT) and epithelioid trophoblastic tumours (ETT) are the rarest malignant forms of gestational trophoblastic disease (GTD). Our prior work demonstrated that an interval of ≥48 months from the antecedent pregnancy was associated with 100% death rate, independent of the stage. Here, we assess whether modified treatments for these patients have increased survival and identify new prognostic factors.
Methods
The United Kingdom GTD database was screened to identify all PSTT/ETT cases diagnosed between 1973 and 2014. Data and survival outcomes from our prior patient cohort (1976–2006) were compared to our new modern cohort (2007–2014), when intensified treatments were introduced.
Results
Of 54,743 GTD patients, 125 (0.23%) were diagnosed with PSTT and/or ETT. Probability of survival at 5 and 10 years following treatment was 80% (95% CI 72.8–87.6%) and 75% (95% CI 66.3–84.3%), respectively. Univariate analysis identified five prognostic factors for reduced overall survival (age, FIGO stage, time since antecedent pregnancy, hCG level, mitotic index) of which stage IV disease (HR 6.18, 95% CI 1.61–23.81,
p
= 0.008) and interval ≥48 months since antecedent pregnancy (HR 14.57, 95% CI 4.17–50.96,
p
< 0.001) were most significant on multivariable analysis. No significant differences in prognostic factors were seen between the old and new patient cohort. However, the new cohort received significantly more cisplatin-based and high-dose chemotherapy, and patients with an interval ≥48 months demonstrated an improved median overall survival (8.3 years, 95% CI 1.53–15.1, versus 2.6 years, 95% CI 0.73–4.44,
p
= 0.·005).
Conclusion
PSTT/ETT with advanced FIGO stage or an interval ≥48 months from their last known pregnancy have poorer outcomes. Platinum-based and high-dose chemotherapy may help to improve survival in poor-prognosis patients.</description><identifier>ISSN: 0007-0920</identifier><identifier>EISSN: 1532-1827</identifier><identifier>DOI: 10.1038/s41416-019-0402-0</identifier><identifier>PMID: 30792530</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>631/67/1517 ; 692/308/409 ; 692/4028/67/1517 ; 692/499 ; 692/699/67/1517 ; Adult ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Biomedical and Life Sciences ; Biomedicine ; Cancer Research ; Chemotherapy ; Chorionic Gonadotropin - blood ; Cisplatin ; Cohort Studies ; Combined Modality Therapy ; Databases, Factual ; Drug Resistance ; Epidemiology ; Female ; Humans ; Hysterectomy ; Medical prognosis ; Molecular Medicine ; Oncology ; Patients ; Placenta ; Platinum ; Pregnancy ; Prognosis ; Retrospective Studies ; Survival ; Trophoblastic disease ; Trophoblastic Neoplasms - blood ; Trophoblastic Neoplasms - mortality ; Trophoblastic Neoplasms - therapy ; Trophoblastic Tumor, Placental Site - blood ; Trophoblastic Tumor, Placental Site - mortality ; Trophoblastic Tumor, Placental Site - therapy ; Tumors ; United Kingdom - epidemiology ; Uterine Neoplasms - blood ; Uterine Neoplasms - mortality ; Uterine Neoplasms - therapy</subject><ispartof>British journal of cancer, 2019-03, Vol.120 (6), p.587-594</ispartof><rights>Cancer Research UK 2019</rights><rights>This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-59a166182f8bf4f3976d0fa5e3b8b4ef87dfbe9cf506b2bdac95d51db2124e103</citedby><cites>FETCH-LOGICAL-c470t-59a166182f8bf4f3976d0fa5e3b8b4ef87dfbe9cf506b2bdac95d51db2124e103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461960/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461960/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,41467,42536,51297,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30792530$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Froeling, Fieke E. M.</creatorcontrib><creatorcontrib>Ramaswami, Ramya</creatorcontrib><creatorcontrib>Papanastasopoulos, Panagiotis</creatorcontrib><creatorcontrib>Kaur, Baljeet</creatorcontrib><creatorcontrib>Sebire, Neil J.</creatorcontrib><creatorcontrib>Short, Dee</creatorcontrib><creatorcontrib>Fisher, Rosemary A.</creatorcontrib><creatorcontrib>Sarwar, Naveed</creatorcontrib><creatorcontrib>Wells, Michael</creatorcontrib><creatorcontrib>Singh, Kam</creatorcontrib><creatorcontrib>Ellis, Laura</creatorcontrib><creatorcontrib>Horsman, Janet M.</creatorcontrib><creatorcontrib>Winter, Matthew C.</creatorcontrib><creatorcontrib>Tidy, John</creatorcontrib><creatorcontrib>Hancock, Barry W.</creatorcontrib><creatorcontrib>Seckl, Michael J.</creatorcontrib><title>Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours</title><title>British journal of cancer</title><addtitle>Br J Cancer</addtitle><addtitle>Br J Cancer</addtitle><description>Background
Placental-site trophoblastic (PSTT) and epithelioid trophoblastic tumours (ETT) are the rarest malignant forms of gestational trophoblastic disease (GTD). Our prior work demonstrated that an interval of ≥48 months from the antecedent pregnancy was associated with 100% death rate, independent of the stage. Here, we assess whether modified treatments for these patients have increased survival and identify new prognostic factors.
Methods
The United Kingdom GTD database was screened to identify all PSTT/ETT cases diagnosed between 1973 and 2014. Data and survival outcomes from our prior patient cohort (1976–2006) were compared to our new modern cohort (2007–2014), when intensified treatments were introduced.
Results
Of 54,743 GTD patients, 125 (0.23%) were diagnosed with PSTT and/or ETT. Probability of survival at 5 and 10 years following treatment was 80% (95% CI 72.8–87.6%) and 75% (95% CI 66.3–84.3%), respectively. Univariate analysis identified five prognostic factors for reduced overall survival (age, FIGO stage, time since antecedent pregnancy, hCG level, mitotic index) of which stage IV disease (HR 6.18, 95% CI 1.61–23.81,
p
= 0.008) and interval ≥48 months since antecedent pregnancy (HR 14.57, 95% CI 4.17–50.96,
p
< 0.001) were most significant on multivariable analysis. No significant differences in prognostic factors were seen between the old and new patient cohort. However, the new cohort received significantly more cisplatin-based and high-dose chemotherapy, and patients with an interval ≥48 months demonstrated an improved median overall survival (8.3 years, 95% CI 1.53–15.1, versus 2.6 years, 95% CI 0.73–4.44,
p
= 0.·005).
Conclusion
PSTT/ETT with advanced FIGO stage or an interval ≥48 months from their last known pregnancy have poorer outcomes. Platinum-based and high-dose chemotherapy may help to improve survival in poor-prognosis patients.</description><subject>631/67/1517</subject><subject>692/308/409</subject><subject>692/4028/67/1517</subject><subject>692/499</subject><subject>692/699/67/1517</subject><subject>Adult</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Cancer Research</subject><subject>Chemotherapy</subject><subject>Chorionic Gonadotropin - blood</subject><subject>Cisplatin</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Databases, Factual</subject><subject>Drug Resistance</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Medical prognosis</subject><subject>Molecular Medicine</subject><subject>Oncology</subject><subject>Patients</subject><subject>Placenta</subject><subject>Platinum</subject><subject>Pregnancy</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Survival</subject><subject>Trophoblastic disease</subject><subject>Trophoblastic Neoplasms - blood</subject><subject>Trophoblastic Neoplasms - mortality</subject><subject>Trophoblastic Neoplasms - therapy</subject><subject>Trophoblastic Tumor, Placental Site - blood</subject><subject>Trophoblastic Tumor, Placental Site - mortality</subject><subject>Trophoblastic Tumor, Placental Site - therapy</subject><subject>Tumors</subject><subject>United Kingdom - epidemiology</subject><subject>Uterine Neoplasms - blood</subject><subject>Uterine Neoplasms - mortality</subject><subject>Uterine Neoplasms - therapy</subject><issn>0007-0920</issn><issn>1532-1827</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU-L1TAUxYMoznP0A7iRgJvZVG_SNm02ggyODgy40XVI25v3MqRJTdIHfgk_s-m8cfwDrkLI7557Tg4hLxm8YVD3b1PDGiYqYLKCBngFj8iOtTWvWM-7x2QHAF0FksMZeZbSbblK6Lun5KyGTvK2hh35ce0z-mSNxYnmA0a9WEzUzksMR6RpjUd71I5qP1E7oc-FHHW2wdNgqC-MowXd-5CyHanRYw4xURMiXZwey4B2VbIZ7xRwsWWHs8GWZTEshzA4fTeY1zmsMT0nT4x2CV_cn-fk69WHL5efqpvPH68v399UY9NBrlqpmRAlpekH05hadmICo1ush35o0PTdZAaUo2lBDHyY9CjbqWXTwBlvsPzdOXl30l3WYcZp8xm1U0u0s47fVdBW_f3i7UHtw1GJRjApNoGLe4EYvq2YspptGtE57TGsSXHWt60QIGVBX_-D3paovsQrlGwYr4urQrETNcaQUkTzYIaB2tpWp7ZVaVttbavNxKs_UzxM_Kq3APwEpPLk9xh_r_6_6k-0K7q8</recordid><startdate>20190319</startdate><enddate>20190319</enddate><creator>Froeling, Fieke E. M.</creator><creator>Ramaswami, Ramya</creator><creator>Papanastasopoulos, Panagiotis</creator><creator>Kaur, Baljeet</creator><creator>Sebire, Neil J.</creator><creator>Short, Dee</creator><creator>Fisher, Rosemary A.</creator><creator>Sarwar, Naveed</creator><creator>Wells, Michael</creator><creator>Singh, Kam</creator><creator>Ellis, Laura</creator><creator>Horsman, Janet M.</creator><creator>Winter, Matthew C.</creator><creator>Tidy, John</creator><creator>Hancock, Barry W.</creator><creator>Seckl, Michael J.</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TO</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190319</creationdate><title>Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours</title><author>Froeling, Fieke E. M. ; Ramaswami, Ramya ; Papanastasopoulos, Panagiotis ; Kaur, Baljeet ; Sebire, Neil J. ; Short, Dee ; Fisher, Rosemary A. ; Sarwar, Naveed ; Wells, Michael ; Singh, Kam ; Ellis, Laura ; Horsman, Janet M. ; Winter, Matthew C. ; Tidy, John ; Hancock, Barry W. ; Seckl, Michael J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-59a166182f8bf4f3976d0fa5e3b8b4ef87dfbe9cf506b2bdac95d51db2124e103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>631/67/1517</topic><topic>692/308/409</topic><topic>692/4028/67/1517</topic><topic>692/499</topic><topic>692/699/67/1517</topic><topic>Adult</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Cancer Research</topic><topic>Chemotherapy</topic><topic>Chorionic Gonadotropin - blood</topic><topic>Cisplatin</topic><topic>Cohort Studies</topic><topic>Combined Modality Therapy</topic><topic>Databases, Factual</topic><topic>Drug Resistance</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Humans</topic><topic>Hysterectomy</topic><topic>Medical prognosis</topic><topic>Molecular Medicine</topic><topic>Oncology</topic><topic>Patients</topic><topic>Placenta</topic><topic>Platinum</topic><topic>Pregnancy</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Survival</topic><topic>Trophoblastic disease</topic><topic>Trophoblastic Neoplasms - blood</topic><topic>Trophoblastic Neoplasms - mortality</topic><topic>Trophoblastic Neoplasms - therapy</topic><topic>Trophoblastic Tumor, Placental Site - blood</topic><topic>Trophoblastic Tumor, Placental Site - mortality</topic><topic>Trophoblastic Tumor, Placental Site - therapy</topic><topic>Tumors</topic><topic>United Kingdom - epidemiology</topic><topic>Uterine Neoplasms - blood</topic><topic>Uterine Neoplasms - mortality</topic><topic>Uterine Neoplasms - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Froeling, Fieke E. M.</creatorcontrib><creatorcontrib>Ramaswami, Ramya</creatorcontrib><creatorcontrib>Papanastasopoulos, Panagiotis</creatorcontrib><creatorcontrib>Kaur, Baljeet</creatorcontrib><creatorcontrib>Sebire, Neil J.</creatorcontrib><creatorcontrib>Short, Dee</creatorcontrib><creatorcontrib>Fisher, Rosemary A.</creatorcontrib><creatorcontrib>Sarwar, Naveed</creatorcontrib><creatorcontrib>Wells, Michael</creatorcontrib><creatorcontrib>Singh, Kam</creatorcontrib><creatorcontrib>Ellis, Laura</creatorcontrib><creatorcontrib>Horsman, Janet M.</creatorcontrib><creatorcontrib>Winter, Matthew C.</creatorcontrib><creatorcontrib>Tidy, John</creatorcontrib><creatorcontrib>Hancock, Barry W.</creatorcontrib><creatorcontrib>Seckl, Michael J.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Froeling, Fieke E. M.</au><au>Ramaswami, Ramya</au><au>Papanastasopoulos, Panagiotis</au><au>Kaur, Baljeet</au><au>Sebire, Neil J.</au><au>Short, Dee</au><au>Fisher, Rosemary A.</au><au>Sarwar, Naveed</au><au>Wells, Michael</au><au>Singh, Kam</au><au>Ellis, Laura</au><au>Horsman, Janet M.</au><au>Winter, Matthew C.</au><au>Tidy, John</au><au>Hancock, Barry W.</au><au>Seckl, Michael J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours</atitle><jtitle>British journal of cancer</jtitle><stitle>Br J Cancer</stitle><addtitle>Br J Cancer</addtitle><date>2019-03-19</date><risdate>2019</risdate><volume>120</volume><issue>6</issue><spage>587</spage><epage>594</epage><pages>587-594</pages><issn>0007-0920</issn><eissn>1532-1827</eissn><abstract>Background
Placental-site trophoblastic (PSTT) and epithelioid trophoblastic tumours (ETT) are the rarest malignant forms of gestational trophoblastic disease (GTD). Our prior work demonstrated that an interval of ≥48 months from the antecedent pregnancy was associated with 100% death rate, independent of the stage. Here, we assess whether modified treatments for these patients have increased survival and identify new prognostic factors.
Methods
The United Kingdom GTD database was screened to identify all PSTT/ETT cases diagnosed between 1973 and 2014. Data and survival outcomes from our prior patient cohort (1976–2006) were compared to our new modern cohort (2007–2014), when intensified treatments were introduced.
Results
Of 54,743 GTD patients, 125 (0.23%) were diagnosed with PSTT and/or ETT. Probability of survival at 5 and 10 years following treatment was 80% (95% CI 72.8–87.6%) and 75% (95% CI 66.3–84.3%), respectively. Univariate analysis identified five prognostic factors for reduced overall survival (age, FIGO stage, time since antecedent pregnancy, hCG level, mitotic index) of which stage IV disease (HR 6.18, 95% CI 1.61–23.81,
p
= 0.008) and interval ≥48 months since antecedent pregnancy (HR 14.57, 95% CI 4.17–50.96,
p
< 0.001) were most significant on multivariable analysis. No significant differences in prognostic factors were seen between the old and new patient cohort. However, the new cohort received significantly more cisplatin-based and high-dose chemotherapy, and patients with an interval ≥48 months demonstrated an improved median overall survival (8.3 years, 95% CI 1.53–15.1, versus 2.6 years, 95% CI 0.73–4.44,
p
= 0.·005).
Conclusion
PSTT/ETT with advanced FIGO stage or an interval ≥48 months from their last known pregnancy have poorer outcomes. Platinum-based and high-dose chemotherapy may help to improve survival in poor-prognosis patients.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>30792530</pmid><doi>10.1038/s41416-019-0402-0</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0007-0920 |
| ispartof | British journal of cancer, 2019-03, Vol.120 (6), p.587-594 |
| issn | 0007-0920 1532-1827 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6461960 |
| source | MEDLINE; Springer Nature - Complete Springer Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | 631/67/1517 692/308/409 692/4028/67/1517 692/499 692/699/67/1517 Adult Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biomedical and Life Sciences Biomedicine Cancer Research Chemotherapy Chorionic Gonadotropin - blood Cisplatin Cohort Studies Combined Modality Therapy Databases, Factual Drug Resistance Epidemiology Female Humans Hysterectomy Medical prognosis Molecular Medicine Oncology Patients Placenta Platinum Pregnancy Prognosis Retrospective Studies Survival Trophoblastic disease Trophoblastic Neoplasms - blood Trophoblastic Neoplasms - mortality Trophoblastic Neoplasms - therapy Trophoblastic Tumor, Placental Site - blood Trophoblastic Tumor, Placental Site - mortality Trophoblastic Tumor, Placental Site - therapy Tumors United Kingdom - epidemiology Uterine Neoplasms - blood Uterine Neoplasms - mortality Uterine Neoplasms - therapy |
| title | Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T06%3A15%3A20IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Intensified%20therapies%20improve%20survival%20and%20identification%20of%20novel%20prognostic%20factors%20for%20placental-site%20and%20epithelioid%20trophoblastic%20tumours&rft.jtitle=British%20journal%20of%20cancer&rft.au=Froeling,%20Fieke%20E.%20M.&rft.date=2019-03-19&rft.volume=120&rft.issue=6&rft.spage=587&rft.epage=594&rft.pages=587-594&rft.issn=0007-0920&rft.eissn=1532-1827&rft_id=info:doi/10.1038/s41416-019-0402-0&rft_dat=%3Cproquest_pubme%3E2185566099%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2194123212&rft_id=info:pmid/30792530&rfr_iscdi=true |