Treatments and outcomes in high‐risk gestational trophoblastic neoplasia: A systematic review and meta‐analysis Article Swipe
Benjamin B. Albright
,
Tressa Ellett
,
Hope Knochenhauer
,
Emily C. Goins
,
Karen Monuszko
,
Samantha Kaplan
,
Rebecca A. Previs
,
Haley Moss
,
Laura J. Havrilesky
,
Brittany A. Davidson
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1111/1471-0528.17374
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1111/1471-0528.17374
Background High‐risk gestational trophoblastic neoplasia (GTN) is rare and treated with diverse approaches. Limited published institutional data has yet to be systematically reviewed. Objectives To compile global high‐risk GTN (prognostic score ≥7) cohorts to summarise treatments and outcomes by disease characteristics and primary chemotherapy. Search Strategy MEDLINE, Embase, Scopus, ClinicalTrials.gov and Cochrane were searched through March 2021. Selection Criteria Full‐text manuscripts reporting mortality among ≥10 high‐risk GTN patients. Data Collection and Analysis Binomial proportions were summed, and random‐effects meta‐analyses performed. Main Results From 1137 records, we included 35 studies, representing 20 countries. Among 2276 unique high‐risk GTN patients, 99.7% received chemotherapy, 35.8% surgery and 4.9% radiation. Mortality was 10.9% (243/2236; meta‐analysis: 10%, 95% confidence interval [CI] 7–12%) and likelihood of complete response to primary chemotherapy was 79.7% (1506/1890; meta‐analysis: 78%, 95% CI: 74–83%). Across 24 reporting studies, modern preferred chemotherapy (EMA/CO or EMA/EP) was associated with lower mortality (overall: 8.8 versus 9.5%; comparative meta‐analysis: 8.1 versus 12.4%, OR 0.42, 95% CI: 0.20–0.90%, 14 studies) and higher likelihood of complete response (overall: 76.6 versus 72.8%; comparative meta‐analysis: 75.9 versus 60.7%, OR 2.98, 95% CI: 1.06–8.35%, 14 studies), though studies focused on non‐preferred regimens reported comparable outcomes. Mortality was increased for ultra‐high‐risk disease (30 versus 7.5% high‐risk; meta‐analysis OR 7.44, 95% CI: 4.29–12.9%) and disease following term delivery (20.8 versus 7.3% following molar pregnancy; meta‐analysis OR 2.64, 95% CI: 1.10–6.31%). Relapse rate estimates ranged from 3 to 6%. Conclusions High‐risk GTN is responsive to several chemotherapy regimens, with EMA/CO or EMA/EP associated with improved outcomes. Mortality is increased in patients with ultra‐high‐risk, relapsed and post‐term pregnancy disease.
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Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1111/1471-0528.17374
- OA Status
- green
- Cited By
- 17
- References
- 71
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4316928592
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4316928592Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1111/1471-0528.17374Digital Object Identifier
- Title
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Treatments and outcomes in high‐risk gestational trophoblastic neoplasia: A systematic review and meta‐analysisWork title
- Type
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reviewOpenAlex work type
- Language
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enPrimary language
- Publication year
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2023Year of publication
- Publication date
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2023-01-17Full publication date if available
- Authors
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Benjamin B. Albright, Tressa Ellett, Hope Knochenhauer, Emily C. Goins, Karen Monuszko, Samantha Kaplan, Rebecca A. Previs, Haley Moss, Laura J. Havrilesky, Brittany A. DavidsonList of authors in order
- Landing page
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https://doi.org/10.1111/1471-0528.17374Publisher landing page
- Open access
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YesWhether a free full text is available
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greenOpen access status per OpenAlex
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https://pmc.ncbi.nlm.nih.gov/articles/PMC10066712/pdf/nihms-1882183.pdfDirect OA link when available
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Meta-analysis, Medicine, Internal medicine, Confidence interval, Relative risk, Hazard ratio, MEDLINE, Law, Political scienceTop concepts (fields/topics) attached by OpenAlex
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17Total citation count in OpenAlex
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2025: 11, 2024: 5, 2023: 1Per-year citation counts (last 5 years)
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71Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.approaches. | 13 |
| abstract_inverted_index.comparative | 153, 175 |
| abstract_inverted_index.gestational | 3 |
| abstract_inverted_index.high‐risk | 28, 66, 96 |
| abstract_inverted_index.manuscripts | 61 |
| abstract_inverted_index.post‐term | 263 |
| abstract_inverted_index.proportions | 74 |
| abstract_inverted_index.chemotherapy | 125, 140, 244 |
| abstract_inverted_index.high‐risk; | 205 |
| abstract_inverted_index.representing | 90 |
| abstract_inverted_index.0.20–0.90%, | 162 |
| abstract_inverted_index.1.06–8.35%, | 184 |
| abstract_inverted_index.4.29–12.9%) | 211 |
| abstract_inverted_index.chemotherapy, | 101 |
| abstract_inverted_index.chemotherapy. | 44 |
| abstract_inverted_index.institutional | 16 |
| abstract_inverted_index.trophoblastic | 4 |
| abstract_inverted_index.1.10–6.31%). | 228 |
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| abstract_inverted_index.characteristics | 41 |
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| abstract_inverted_index.meta‐analysis | 206, 223 |
| abstract_inverted_index.non‐preferred | 191 |
| abstract_inverted_index.meta‐analysis: | 111, 129, 154, 176 |
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| abstract_inverted_index.ultra‐high‐risk, | 260 |
| cited_by_percentile_year.max | 99 |
| cited_by_percentile_year.min | 89 |
| corresponding_author_ids | https://openalex.org/A5048470561 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 10 |
| corresponding_institution_ids | https://openalex.org/I4210126298 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.7699999809265137 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.96198483 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |