1
|
Zhang T, Guo Y, He X, Hou M, Wang L, An R, Gao L. Effect of lung metastasis on the treatment and prognosis of patients with gestational trophoblastic neoplasia: A systematic review and meta-analysis. Acta Obstet Gynecol Scand 2024; 103:636-644. [PMID: 38282348 PMCID: PMC10993365 DOI: 10.1111/aogs.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Gestational trophoblastic neoplasia (GTN) is a highly invasive tumor, mainly spreading to the lungs. However, lung metastasis in GTN is usually not considered as an adverse prognostic factor. Therefore, the aim of this study was to summarize the results of previous studies and evaluate the effects of lung metastasis on the treatment and prognosis of GTN. MATERIAL AND METHODS The study was prospectively registered in PROSPERO (CRD42023372371). Electronic databases including PubMed, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, and China Biomedical Literature Database were used for a systematical search of relevant studies published up to November 21, 2022. The observational studies reporting the clinical outcomes of GTN patients with and without lung metastasis were selected. The incidences of resistance, relapse, and mortality of GTN patients were extracted and successively grouped based on the presence of lung metastasis. The pooled relative risks (RRs) and 95% confidence interval (95% CI) of the eligible studies were calculated. The qualities of included studies were assessed with the Newcastle-Ottawa Scale and the certainty of evidence was graded based on the GRADE. The meta-analysis was performed using Stata 12.0 and GradePro software. RESULTS Five publications with 3629 GTN patients were included. The meta-analysis revealed that the GTN with lung metastasis was strongly correlated with first-line chemoresistance (pooled RR = 1.40, 95% CI: 1.22 to 1.61, p < 0.001), recurrence (pooled RR = 3.03, 95% CI: 1.21 to 7.62, p = 0.018), and disease-specific death (pooled RR = 22.11, 95% CI: 3.37 to 145.08, p = 0.001). Ethnicity was also an important factor and Caucasian GTN patients with lung metastasis showed a higher risk of recurrence as revealed by the subgroup analysis (pooled RR = 5.10, 95% CI: 2.38 to 10.94, p < 0.001). CONCLUSIONS GTN patients with lung metastasis exhibited a higher risk of chemoresistance, relapse, and disease-specific death. Patients with lung metastasis among the Caucasian population had a higher risk of recurrence than Asian populations. Therefore, the presence of lung metastases might be considered as a high-risk factor for prognosis of GTN and deserves more attention in the choice of first-line chemotherapy regimens and follow-up.
Collapse
Affiliation(s)
- Taohong Zhang
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityShaanxiChina
| | - Ying Guo
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityShaanxiChina
| | - Xinyi He
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityShaanxiChina
| | - Meng Hou
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityShaanxiChina
| | - Lisha Wang
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityShaanxiChina
| | - Ruifang An
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityShaanxiChina
| | - Li Gao
- Department of Obstetrics and GynecologyThe First Affiliated Hospital of Xi'an Jiaotong UniversityShaanxiChina
| |
Collapse
|
2
|
Guo Y, Zhang T, He X, Xu H, Wang L, Zhou W, Gao L, An R. A meta-analysis of predictive value of blood biomarkers in gestational trophoblastic neoplasia. Future Oncol 2024; 20:381-392. [PMID: 38456312 DOI: 10.2217/fon-2023-0919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to play a diagnostic and predictive role in gestational trophoblastic disease. However, the conclusions are still ambiguous. This meta-analysis aimed to evaluate the combined predictive value of NLR and PLR in the malignant progression of gestational trophoblastic disease. Method: Electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, Wanfang and China Biomedical Literature Database were searched for the relevant literature published up to 1 October 2022. Study selection and data extraction were performed independently by two reviewers. All analyses were performed using Revman, MetaDisc and STATA software. Results: A total of 858 patients from five studies were included in this meta-analysis. The pooled sensitivity and specificity of NLR were 0.8 (95% CI: 0.71-0.88) and 0.73 (95% CI: 0.69-0.76), respectively, and the area under curve of the summary receiver operating curve was 0.81. The pooled sensitivity and specificity of PLR were 0.87 (95% CI: 0.75-0.95) and 0.49 (95% CI: 0.44-0.54), respectively, and the area under curve of the summary receiver operating curve was 0.88. I2 statistic and Deek's funnel plot showed no heterogeneity and publication bias. Conclusion: NLR can accurately predict the progression from hydatidiform mole to gestational trophoblastic neoplasia and is a promising biomarker in further follow-up.
Collapse
Affiliation(s)
- Ying Guo
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Taohong Zhang
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Xinyi He
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Huiqiu Xu
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Lisha Wang
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Weihua Zhou
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Li Gao
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Ruifang An
- Department of Obstetrics & Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| |
Collapse
|
3
|
Wang W, Kong Y, Li Y, Wan X, Feng F, Ren T, Zhao J, Xiang Y, Yang J. Pulmonary resection of residual lesions of pulmonary metastasis from gestational trophoblastic neoplasia. Int J Gynecol Cancer 2023; 33:1376-1382. [PMID: 37524495 PMCID: PMC10511965 DOI: 10.1136/ijgc-2023-004375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To evaluate the prognosis and recurrence in patients with residual lesions of pulmonary metastasis from gestational trophoblastic neoplasia after initial treatment, and to explore the clinical significance of pulmonary resection. METHODS A retrospective analysis was performed on 606 patients with residual lesions from pulmonary metastasis after receiving standardized chemotherapy as initial treatment in Peking Union Medical College Hospital from January 2002 to December 2018. Patients were divided into surgery (51 patients) and non-surgery (555 patients) groups. The prognosis of these patients was compared. Risk factors affecting recurrence were analyzed to explore the effect of pulmonary resection. RESULTS Among low risk patients, complete remission rate was 100% and recurrence rate was <1% in both groups. Among high risk patients, complete remission and recurrence rates were 93.5% and 10.3% in the surgery group and 94.7% and 14.3% in the non-surgery group, respectively. There was no significant difference in prognostic features between the two groups (all p>0.05). No significant difference was found in recurrence rates based on recurrence risk factors (≥3.2 cm residual lung lesions, prognosis score ≥9.0, and drug resistance) between the two groups (all p>0.05). CONCLUSION After standardized chemotherapy, pulmonary resection was not necessary for initially treated stage III gestational trophoblastic neoplasia patients whose blood β human chorionic gonadotropin levels normalized and residual lung lesions remained stable. These patients should be closely monitored during follow-up, regardless of the size of the residual lung lesions or high/low risk score, especially within a year after complete remission.
Collapse
Affiliation(s)
- Weidi Wang
- Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Disease, Beijing, China
| | - Yujia Kong
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
| | - Yuan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
| | - Xirun Wan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
| | - Tong Ren
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
| | - Jun Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetrics and Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Beijing, China
| |
Collapse
|
4
|
Hu Q, Li M, Liu Y, Xie M, Wang L. Exploring the real cause of hemoptysis: A case of pulmonary tumor embolism in a young woman with accompanying pulmonary metastasis of gestational trophoblastic neoplasia. Pulm Circ 2023; 13:e12248. [PMID: 37292090 PMCID: PMC10247309 DOI: 10.1002/pul2.12248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/18/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
We report a case of pulmonary embolism caused by gestational trophoblastic neoplasia (GTN) accompanied by pulmonary metastasis to improve the recognition ability of the disease in young female patients with pulmonary embolism and hemoptysis.
Collapse
Affiliation(s)
- Qun Hu
- Department of Respiratory and Critical Care Medicine, West China HospitalSichuan UniversityChengduChina
| | - Meiqian Li
- Department of Critical Care Medicine, West China HospitalSichuan UniversityChengduChina
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine, West China HospitalSichuan UniversityChengduChina
| | - Min Xie
- Department of Respiratory and Critical Care Medicine, West China HospitalSichuan UniversityChengduChina
| | - Lan Wang
- Department of Respiratory and Critical Care Medicine, West China HospitalSichuan UniversityChengduChina
| |
Collapse
|
5
|
Li J, Wang Y, Lu B, Lu W, Xie X, Shen Y. Gestational trophoblastic neoplasia with extrauterine metastasis but lacked uterine primary lesions: a single center experience and literature review. BMC Cancer 2022; 22:509. [PMID: 35524210 PMCID: PMC9077999 DOI: 10.1186/s12885-022-09620-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background To investigate the clinicopathological characteristics, diagnoses, treatments, and outcomes of a special type of gestational trophoblastic neoplasia (GTN) which only has extrauterine metastases without uterine primary lesions. Methods The medical records and pathological sections of the patients who were pathologically diagnosed as GTN, only had extrauterine metastatic lesions but lacked uterine primary lesions, in Women’s Hospital of Zhejiang University School of Medicine from February 2014 to March 2021 were collected and reviewed. Results Thirteen patients with pathologically confirmed GTN presenting with extrauterine metastases from a missing primary site were included in the past 7 years. The median age was 31.2 years old. 76.9% of patients had a non-hydatidiform pregnancy last time. The intervals between the antecedent pregnancy were > 12 months in 61.5% of patients. Pretreatment serum human chorionic gonadotropin(hCG) levels ranged from 118.7 to 807,270 IU/L. Six patients were misdiagnosed as ectopic pregnancy at initial diagnosis, and 4 as primary tumors at metastatic sites. All of them were diagnosed definitely by surgical pathology including 8 choriocarcinomas (CC), 4 epithelioid trophoblastic tumors (ETTs), and 1 mixed GTN (CC mixed with ETT). All patients achieved complete remission (CR) after treatments. Three patients relapsed; no patient died by the end of follow-up. Conclusion GTN presenting with extrauterine metastases from a missing primary site is easily misdiagnosed. Detection of serum hCG in these patients can reduce misdiagnosis. Chemotherapy combined with individualized surgery should be considered for these special GTN patients. Immune checkpoint inhibitors might be potential remedial measures for refractory and recurrent patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09620-2.
Collapse
Affiliation(s)
- Jingnan Li
- School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, 310058, China
| | - Yu Wang
- School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, 310058, China
| | - Bingjian Lu
- Department of Gynecologic Oncology, School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, 310006, China
| | - Weiguo Lu
- Center of Uterine Cancer Diagnosis & Therapy of Zhejiang Province, Hangzhou, 310006, China
| | - Xing Xie
- Cancer Center, Zhejiang University, Hangzhou, 310058, China
| | - Yuanming Shen
- Department of Gynecologic Oncology, School of Medicine, Women's Hospital, Zhejiang University, Hangzhou, 310006, China.
| |
Collapse
|