Complete Resection Is Essential in the Surgical Treatment of Gestational Trophoblastic Neoplasia

Kathleen Gong Essel, Aaron Shafer, Amanda Bruegl, David M. Gershenson, Lane K. Drury, Lois M. Ramondetta, R. Wendel Naumann, Jubilee Brown

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: The aim of this study was to determine the utility of surgery in patients with gestational trophoblastic neoplasia (GTN).

MATERIALS AND METHODS: We performed a retrospective institutional review board-approved analysis of all patients with GTN at a single institution from 1985 to 2015 and compared all patients who underwent surgery as definitive management for their disease to a matched cohort of those who did not. Kaplan-Meier curves were used to estimate progression-free survival (PFS) and overall survival (OS).

RESULTS: Sixty-nine patients underwent a total of 94 surgeries as definitive treatment for GTN. Nineteen patients had multiple surgeries. Progression-free survival and OS were improved in patients with complete macroscopic surgical resection (n = 61) compared with patients with gross residual disease (n = 33) (median PFS 91.2 months vs 3.3 months, and median OS not reached at 108.8 months vs 66.3 months, respectively; P < 0.05). The nature of the surgery (emergent vs planned) and site of metastatic disease did not influence PFS or OS. Of the 61 patients with no visible residual disease, 17 received adjuvant chemotherapy and 44 did not; there were no observed differences in PFS or OS. Patients who underwent surgery as part of definitive treatment (n = 69 patients) were compared with patients with GTN over the same period who received chemotherapy alone (n = 33 patients). Median PFS was improved in the surgical group (5.9 vs 5.1 months, P < 0.01), but OS was not significantly different (P = 0.37).

CONCLUSIONS: Complete resection results in improved outcomes in patients who undergo surgery for GTN, whether emergent or planned, independent of disease site, and should be considered as an important component of treatment in some situations.

Original languageEnglish (US)
Pages (from-to)1453-1460
Number of pages8
JournalInternational journal of gynecological cancer : official journal of the International Gynecological Cancer Society
Volume28
Issue number8
DOIs
StatePublished - Oct 1 2018

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Gestational Trophoblastic Disease
Disease-Free Survival
Survival
Therapeutics
Research Ethics Committees
Adjuvant Chemotherapy
Disease Management

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Complete Resection Is Essential in the Surgical Treatment of Gestational Trophoblastic Neoplasia. / Essel, Kathleen Gong; Shafer, Aaron; Bruegl, Amanda; Gershenson, David M.; Drury, Lane K.; Ramondetta, Lois M.; Naumann, R. Wendel; Brown, Jubilee.

In: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society, Vol. 28, No. 8, 01.10.2018, p. 1453-1460.

Research output: Contribution to journalArticle

Essel, Kathleen Gong ; Shafer, Aaron ; Bruegl, Amanda ; Gershenson, David M. ; Drury, Lane K. ; Ramondetta, Lois M. ; Naumann, R. Wendel ; Brown, Jubilee. / Complete Resection Is Essential in the Surgical Treatment of Gestational Trophoblastic Neoplasia. In: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2018 ; Vol. 28, No. 8. pp. 1453-1460.
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AU - Essel, Kathleen Gong

AU - Shafer, Aaron

AU - Bruegl, Amanda

AU - Gershenson, David M.

AU - Drury, Lane K.

AU - Ramondetta, Lois M.

AU - Naumann, R. Wendel

AU - Brown, Jubilee

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N2 - OBJECTIVE: The aim of this study was to determine the utility of surgery in patients with gestational trophoblastic neoplasia (GTN).MATERIALS AND METHODS: We performed a retrospective institutional review board-approved analysis of all patients with GTN at a single institution from 1985 to 2015 and compared all patients who underwent surgery as definitive management for their disease to a matched cohort of those who did not. Kaplan-Meier curves were used to estimate progression-free survival (PFS) and overall survival (OS).RESULTS: Sixty-nine patients underwent a total of 94 surgeries as definitive treatment for GTN. Nineteen patients had multiple surgeries. Progression-free survival and OS were improved in patients with complete macroscopic surgical resection (n = 61) compared with patients with gross residual disease (n = 33) (median PFS 91.2 months vs 3.3 months, and median OS not reached at 108.8 months vs 66.3 months, respectively; P < 0.05). The nature of the surgery (emergent vs planned) and site of metastatic disease did not influence PFS or OS. Of the 61 patients with no visible residual disease, 17 received adjuvant chemotherapy and 44 did not; there were no observed differences in PFS or OS. Patients who underwent surgery as part of definitive treatment (n = 69 patients) were compared with patients with GTN over the same period who received chemotherapy alone (n = 33 patients). Median PFS was improved in the surgical group (5.9 vs 5.1 months, P < 0.01), but OS was not significantly different (P = 0.37).CONCLUSIONS: Complete resection results in improved outcomes in patients who undergo surgery for GTN, whether emergent or planned, independent of disease site, and should be considered as an important component of treatment in some situations.

AB - OBJECTIVE: The aim of this study was to determine the utility of surgery in patients with gestational trophoblastic neoplasia (GTN).MATERIALS AND METHODS: We performed a retrospective institutional review board-approved analysis of all patients with GTN at a single institution from 1985 to 2015 and compared all patients who underwent surgery as definitive management for their disease to a matched cohort of those who did not. Kaplan-Meier curves were used to estimate progression-free survival (PFS) and overall survival (OS).RESULTS: Sixty-nine patients underwent a total of 94 surgeries as definitive treatment for GTN. Nineteen patients had multiple surgeries. Progression-free survival and OS were improved in patients with complete macroscopic surgical resection (n = 61) compared with patients with gross residual disease (n = 33) (median PFS 91.2 months vs 3.3 months, and median OS not reached at 108.8 months vs 66.3 months, respectively; P < 0.05). The nature of the surgery (emergent vs planned) and site of metastatic disease did not influence PFS or OS. Of the 61 patients with no visible residual disease, 17 received adjuvant chemotherapy and 44 did not; there were no observed differences in PFS or OS. Patients who underwent surgery as part of definitive treatment (n = 69 patients) were compared with patients with GTN over the same period who received chemotherapy alone (n = 33 patients). Median PFS was improved in the surgical group (5.9 vs 5.1 months, P < 0.01), but OS was not significantly different (P = 0.37).CONCLUSIONS: Complete resection results in improved outcomes in patients who undergo surgery for GTN, whether emergent or planned, independent of disease site, and should be considered as an important component of treatment in some situations.

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