Introduction
Gestational trophoblastic neoplasia (GTN) is a type of curable neoplasm and the rate of overall survival (OS) following standardized chemotherapy is greater than 90% 1-4. Low-risk GTN patients (International Federation of Obstetrics and Gynecology [FIGO] score ≤6) should be treated with a single agent, with a rate of OS approaching 100%. High-risk GTN patients (FIGO score ≥7) require multi-agent chemotherapy, with a survival rate of approximately 90%5, 6. The FIGO Cancer Report 2021 divides GTN patients with FIGO score ≥7 into a high-risk subgroup (7 ≤FIGO score ≤12) and ultra-high-risk subgroup (FIGO score >12, as well as patients with liver, brain, or extensive metastases), and the latter do poorly when treated with first-line multiple-agent chemotherapy6. Most high-risk GTN patients develop many metastases of any type over months or years after the causative pregnancy 4. The long-term survival is only 27% when there is metastasis to the liver, 70% with brain metastases, and 10% with both sites of metastasis 4, 7. The presence of liver, brain, or kidney metastases (relative risk [RR] 4.99, 95% confidence interval [CI] 1.96–12.71) is the strongest risk factor for death in patients with GTN 2, 8.
There is limited available information about liver or brain metastases in GTN owing to its rarity 7, 9-12. Randomized controlled trials (RCTs) on GTN are scarce because of the low prevalence of this disease and its highly chemo-sensitive nature11, 13. Optimal treatment strategies for patients with liver or brain metastases have not been identified. Hence, we carried out a retrospective analysis and report the clinical characteristics, treatment details, outcome, and prognosis in the management of ultra-high-risk GTN patients with liver or brain metastases at our center.