Outcome of Different Treatment Modalities For Gestational Trophoblastic Neoplasia in Women At 40 Years Old or Above : a Multicenter Retrospective Study
Notice bibliographique
Résumé
Objective: To investigate the outcome of different treatment strategies in patients with gestational trophoblastic neoplasia (GTN) at 40 years old or above.Methods: A retrospective analysis of data from 5 referral centers from 5 countries (Egypt, Canada, Ukraine, Saudi Arabia, and Indonesia) during 5 years periods (from 1st of April, 2012 to 31th of March, 2017). Medical records of 118 women with GTN who were at 40 years old or above were retrieved, reviewed and analyzed. Demographic criteria and outcome of different treatment strategies were evaluated. The patients were categorized into 4 groups; low-risk non metastatic, low-risk metastatic, high-risk, and patients with special histology (placental-site trophoblastic tumors u201cPSTTu201d and epithelioid trophoblastic tumors u201cETTu201d). Results: Of 118 included cases; mean age was 45.46 yearsu00b14.27 SD, and median hCG was 2616.0 m.IU/ml. Low-risk non-metastatic cases represented 67.8%, low-risk metastatic 11.9%, while 15.3% were in high-risk group. Most of the patients were in FIGO stage I (76.2%). Metastases were diagnosed in 28 cases (23.7%), lungs were commonest site (75.0%). The commonest histopathological type was invasive mole (40.2%). Of 80 patients with low risk non metastatic GTN, 32 women were treated with single chemotherapy, 14 cases underwent a second curettage with methotrexate, and 34 cases hysterectomy with or without chemotherapy was performed. Upfront hysterectomy with or without monochemotherapy was associated with more remission rate (P=0.001) and least treatment duration (P=0.002). Of 14 patients with low risk metastatic GTN, 8 women were treated with single chemotherapy while in 6 patients a hysterectomy was performed and MTX was started immediately in all. Complete response occurred only in 7/14 (50%). Two high risk patients died before treatment could start and two cases died during treatment due to presence of distant metastases. Ten cases had underwent hysterectomy and chemotherapy as first line; 6/10 (60%) showed complete response. Four women used EMA/CO combination chemotherapy alone; two of them (50%) had incomplete response and needed 2nd line treatment of EMA/EP combination. Conclusion. For low-risk non-metastatic disease; hysterectomy with 1-2 courses of monochemotherapy was more successful while in high-risk disease; hysterectomy with combination chemotherapy was associated with better remission rate. A large prospective randomized study is recommended to verify these findings.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,000 |
| Bibliométrie | 0,020 | 0,005 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,006 |
| Science ouverte | 0,005 | 0,005 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».