Objective: Presence of lung metastases in low-risk gestational trophoblastic neoplasia (GTN) is generally considered not to influence prognosis. However, in a recent study in the Netherlands, GTN patients with lung metastases had a higher recurrence rate and more disease-specific deaths compared with patients without metastases. The aim of the present study was to validate these findings in a different country. Design: Historical cohort study. Setting: Charing Cross Hospital, United Kingdom. Population: A total of 1040 low-risk GTN patients treated with methotrexate (MTX) between 2002 and 2016 were identified: 65 with lung metastases (group 1) and 975 without metastases (group 2). Methods: Baseline characteristics, MTX resistance, survival and recurrence rates were recorded and compared between both groups. Main outcome measures: MTX resistance, recurrence rate and survival. Results: The occurrence of MTX resistance and median number of MTX courses to achieve remission was significantly higher in patients with lung metastases than patients without metastases (60% versus 38.9%, P = 0.001; and nine versus six courses, P < 0.001). All choriocarcinoma patients (n = 4) with lung metastases developed MTX resistance. The recurrence rate was also higher in group I (9.2% versus 2.7%; P = 0.012). Disease-specific survival was 100% in both groups. Conclusions: The presence of lung metastases at the start of MTX therapy is associated with increased incidence of MTX resistance and recurrence in low-risk GTN without affecting overall survival, which remains 100%. However, individuals with low-risk choriocarcinoma with lung metastases are likely to become resistant to MTX and primary multi-agent chemotherapy should be considered. Tweetable abstract: The presence of lung metastases appears to increase the risk of recurrence in low-risk GTN, but does not affect overall cure rates and survival.

Additional Metadata
Keywords Gestational trophoblastic neoplasia, lung metastases, methotrexate, recurrence
Persistent URL dx.doi.org/10.1111/1471-0528.16036, hdl.handle.net/1765/122938
Journal BJOG: An International Journal of Obstetrics and Gynaecology
Citation
Frijstein, M.M, Lok, C.A, van Trommel, N.E, ten Kate-Booij, M.J, Massuger, L.F, van Werkhoven, E.D, … Seckl, M.J. (2019). Lung metastases in low-risk gestational trophoblastic neoplasia: a retrospective cohort study. BJOG: An International Journal of Obstetrics and Gynaecology. doi:10.1111/1471-0528.16036