Outcome of Different Treatment Modalities For Gestational Trophoblastic Neoplasia in Women At 40 Years Old or Above : a Multicenter Retrospective Study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.000 |
| Bibliometrics | 0.020 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.006 |
| Open science | 0.005 | 0.005 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".