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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, indepen...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461960/
https://www.ncbi.nlm.nih.gov/pubmed/30792530
http://dx.doi.org/10.1038/s41416-019-0402-0
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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_facet 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 Froeling, Fieke E. M.
collection PubMed
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.
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spelling pubmed-64619602020-02-22 Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours 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. Br J Cancer Article 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. Nature Publishing Group UK 2019-02-22 2019-03-19 /pmc/articles/PMC6461960/ /pubmed/30792530 http://dx.doi.org/10.1038/s41416-019-0402-0 Text en © Cancer Research UK 2019 https://creativecommons.org/licenses/by/4.0/ This work is published under the standard license to publish agreement. After 12 months the work will become freely available and the license terms will switch to a Creative Commons Attribution 4.0 International (CC BY 4.0).
spellingShingle Article
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.
Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
title Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
title_full Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
title_fullStr Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
title_full_unstemmed Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
title_short Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
title_sort intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461960/
https://www.ncbi.nlm.nih.gov/pubmed/30792530
http://dx.doi.org/10.1038/s41416-019-0402-0
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