Emelie Wallin

Treatment outcomes and the role of surgery in gestational trophoblastic neoplasia: a population-based cohort study

Background and purpose: Cure rates of gestational trophoblastic neoplasia (GTN) are excellent, however the surgical interventions in disease management are not well described. The primary aim of this study was to investigate the incidence and types of surgical procedures used for management of GTN and to report treatment outcomes in a population-based cohort. The secondary aim was to assess the impact of hysterectomy on time to human chorionic gonadotropin (hCG)-normalisation in low-risk GTN. Material and methods: Medical records of all patients treated for GTN at Karolinska University Hospital, Stockholm, Sweden between 1994 and 2020 were screened for treatment outcomes, types of surgical procedures and complications. Regression models were used to assess if hysterectomy affected time to complete remission in low-risk GTN. Results and interpretation: Over the 27-year study period, 185 patients with GTN were included. The primary complete remission rate was 98.4% and relapse rate 3.2%. Sixty-four patients (34.6%) underwent at least one surgical procedure; 39/154 (25.3%) of low-risk patients, 17/23 (73.9%) of high-risk patients and all (100%) patients with placental site or epithelioid trophoblastic tumour. No severe complications (Clavien-Dindo ≥3) were observed. Seven of 74 procedures (9.5%) were complicated by bleeding >1,000 mL or surgical site infection. Therapeutic hysterectomy significantly shortened time to hCG-normalisation in the low-risk group (48 vs 74 days, p = 0.002). This population-based study confirms the excellent cure rates and low relapse rates for GTN. Surgery plays an important role in the management of GTN with low risk of complications. Hysterectomy shortens time to hCG normalisation.