Treatment outcome
The initial chemotherapy drug-resistance rate was 90.0% (10/11) in 11 ultra-high-risk GTN patients with liver or brain metastases. Ultimately, of the 11 ultra-high-risk GTN patients with liver or brain metastases, nine were long-term survivors and two patients died. As detailed in Table 2, of the patients who died, one had early death within four weeks after treatment initiation for cerebral hernia and multiple organ failure. Another patient died despite receiving optimal standard dose chemotherapy after developing severe bone marrow failure 23 months from the initial chemotherapy (Table 2).
The CR rate after initial treatment was 11.1% and the drug-resistance rate with initial treatment was 72.2% in 18 ultra-high-risk GTN patients. There was a significantly lower CR rate (0% vs. 28.6%,P <0.01) and higher drug-resistance rate (90.0% vs 42.9%, P <0.01) after initial treatment in ultra-high-risk GTN patients with liver or brain metastases. (n=18) (Table 3).