Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
Intensified therapies improve survival and identification of novel prognostic factors for placental-site and epithelioid trophoblastic tumours
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DOI：
10.1038/s41416-019-0402-0
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发表时间：
2019-03-19
影响因子：
8.8
通讯作者：
Seckl, Michael J.
中科院分区：
文献类型：
--
作者：
Froeling, Fieke E. M.;Ramaswami, Ramya;Seckl, Michael J.
背景：胎盘部位滋养细胞肿瘤（PSTT）和上皮样滋养细胞肿瘤（ETT）是妊娠滋养细胞疾病（GTD）最罕见的恶性形式。我们之前的研究表明，与前次妊娠的间隔 >= 48 个月与 100% 死亡率相关，与阶段无关。在这里，我们评估这些患者的改良治疗是否可以提高生存率并确定新的预后因素。方法：对英国 GTD 数据库进行筛选，以识别 1973 年至 2014 年间诊断的所有 PSTT/ETT 病例。将我们先前患者队列（1976-2006）的数据和生存结果与引入强化治疗时的新现代队列（2007-2014）进行比较。结果：54,743 例GTD 患者中，125 名（0.23%）被诊断为 PSTT 和/或 ETT。治疗后 5 年和 10 年的生存概率分别为 80% (95% CI 72.8-87.6%) 和 75% (95% CI 66.3-84.3%)。单变量分析确定了导致总生存率降低的 5 个预后因素（年龄、FIGO 分期、距前次妊娠的时间、hCG 水平、有丝分裂指数），其中 IV 期疾病（HR 6.18，95% CI 1.61-23.81，p = 0.008）和距前次妊娠的时间间隔 >= 48 个月（HR 14.57，95% CI） 4.17-50.96，p < 0.001）在多变量分析中最为显着。新旧患者队列之间的预后因素没有显着差异。然而，新队列接受了明显更多的以顺铂为基础的高剂量化疗，并且间隔≥ 48个月的患者表现出中位总生存期的改善（8.3年，95% CI 1.53-15.1，对比2.6年，95% CI 0.73-4.44，p = 0.005）。结论：晚期FIGO分期或间隔= 48个月的PSTT/ETT他们最后一次已知的怀孕结果较差。以铂类为基础的高剂量化疗可能有助于提高预后不良患者的生存率。
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.