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.