The evolving role of hysterectomy in gestational Trophoblastic neoplasia at the new England trophoblastic disease center

Rachel M. Clark, Nicole S. Nevadunsky, Sue Ghosh, Donald P. Goldstein, Ross S. Berkowitz

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Abstract

OBJECTIVE: To identify indications for hysterectomy in patients with gestational trophoblastic neoplasia (GTN) and to evaluate outcomes of hysterectomy in those patients. STUDY DESIGN: Patients who underwent hysterectomy were identified utilizing hospital medical records and the New England Trophoblastic Disease Center (NETDC) database from January 1, 1959-January 1, 2009. Demographic data as well as indication for hysterectomy, stage, World Health Organization score, chemotherapeutic regimens and outcomes were recorded. We further stratified our population into patients with hysterectomies before and after 1980 to assess how indications for and outcomes after hysterectomy may have changed at our institution over time. RESULTS: A total of 98 patients were identified to have undergone hysterectomy for GTN. In the entire cohort 85% (n= 83) achieved remission and 48% (n= 47) required chemotherapy after hysterectomy. Among the patients in the early cohort (n=49), indications for hysterectomy included 15 (31%) for primary definitive management, 14 (29%) for chemotherapy resistant disease, 14 (29%) for bleeding and 6 (11%) for other reasons. Of the patients with hysterectomy for chemotherapy resistance, 9 (64%) achieved remission. In the more recent cohort (n = 49) indications for hysterectomy included 24 (49%) for primary definitive management, 19 (39%) for drugresistant disease, 4 (8%) for bleeding and 2 (4%) for other reasons. Of the patients with hysterectomy for chemotherapy resistance, 16 (84%) achieved remission. There was a statistically significant decline in the number of hysterectomies performed for bleeding. Hysterectomy was performed for bleeding in the early cohort (1959-1980) in 14 (29%) of 49 patients but in only 4 (8%) of 49 patients in the later cohort (1981-2009) (p=0.02). CONCLUSION: During the years 1959-2009 the number of hysterectomies performed for GTN at the NETDC has remained stable. However, at our center there has been a decline in the incidence of hysterectomy for lifethreatening hemorrhage. Overall 83 (84.7%) patients with hysterectomy for GTN obtained remission. In pa-tients who underwent hysterectomy to treat chemotherapyresistant disease, 25 of 33 (75.8%) subsequently achieved complete remission. Hysterectomy continues to play an important role in the management of selected patients with GTN.

Original languageEnglish (US)
Pages (from-to)194-198
Number of pages5
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume55
Issue number5-6
StatePublished - May 2010
Externally publishedYes

Fingerprint

Gestational Trophoblastic Disease
New England
Hysterectomy
Hemorrhage
Drug Therapy

Keywords

  • Chemotherapy
  • Gestational trophoblastic neoplasia
  • Hysterectomy
  • Surgery

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

The evolving role of hysterectomy in gestational Trophoblastic neoplasia at the new England trophoblastic disease center. / Clark, Rachel M.; Nevadunsky, Nicole S.; Ghosh, Sue; Goldstein, Donald P.; Berkowitz, Ross S.

In: Journal of Reproductive Medicine for the Obstetrician and Gynecologist, Vol. 55, No. 5-6, 05.2010, p. 194-198.

Research output: Contribution to journalArticle

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title = "The evolving role of hysterectomy in gestational Trophoblastic neoplasia at the new England trophoblastic disease center",
abstract = "OBJECTIVE: To identify indications for hysterectomy in patients with gestational trophoblastic neoplasia (GTN) and to evaluate outcomes of hysterectomy in those patients. STUDY DESIGN: Patients who underwent hysterectomy were identified utilizing hospital medical records and the New England Trophoblastic Disease Center (NETDC) database from January 1, 1959-January 1, 2009. Demographic data as well as indication for hysterectomy, stage, World Health Organization score, chemotherapeutic regimens and outcomes were recorded. We further stratified our population into patients with hysterectomies before and after 1980 to assess how indications for and outcomes after hysterectomy may have changed at our institution over time. RESULTS: A total of 98 patients were identified to have undergone hysterectomy for GTN. In the entire cohort 85{\%} (n= 83) achieved remission and 48{\%} (n= 47) required chemotherapy after hysterectomy. Among the patients in the early cohort (n=49), indications for hysterectomy included 15 (31{\%}) for primary definitive management, 14 (29{\%}) for chemotherapy resistant disease, 14 (29{\%}) for bleeding and 6 (11{\%}) for other reasons. Of the patients with hysterectomy for chemotherapy resistance, 9 (64{\%}) achieved remission. In the more recent cohort (n = 49) indications for hysterectomy included 24 (49{\%}) for primary definitive management, 19 (39{\%}) for drugresistant disease, 4 (8{\%}) for bleeding and 2 (4{\%}) for other reasons. Of the patients with hysterectomy for chemotherapy resistance, 16 (84{\%}) achieved remission. There was a statistically significant decline in the number of hysterectomies performed for bleeding. Hysterectomy was performed for bleeding in the early cohort (1959-1980) in 14 (29{\%}) of 49 patients but in only 4 (8{\%}) of 49 patients in the later cohort (1981-2009) (p=0.02). CONCLUSION: During the years 1959-2009 the number of hysterectomies performed for GTN at the NETDC has remained stable. However, at our center there has been a decline in the incidence of hysterectomy for lifethreatening hemorrhage. Overall 83 (84.7{\%}) patients with hysterectomy for GTN obtained remission. In pa-tients who underwent hysterectomy to treat chemotherapyresistant disease, 25 of 33 (75.8{\%}) subsequently achieved complete remission. Hysterectomy continues to play an important role in the management of selected patients with GTN.",
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T1 - The evolving role of hysterectomy in gestational Trophoblastic neoplasia at the new England trophoblastic disease center

AU - Clark, Rachel M.

AU - Nevadunsky, Nicole S.

AU - Ghosh, Sue

AU - Goldstein, Donald P.

AU - Berkowitz, Ross S.

PY - 2010/5

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N2 - OBJECTIVE: To identify indications for hysterectomy in patients with gestational trophoblastic neoplasia (GTN) and to evaluate outcomes of hysterectomy in those patients. STUDY DESIGN: Patients who underwent hysterectomy were identified utilizing hospital medical records and the New England Trophoblastic Disease Center (NETDC) database from January 1, 1959-January 1, 2009. Demographic data as well as indication for hysterectomy, stage, World Health Organization score, chemotherapeutic regimens and outcomes were recorded. We further stratified our population into patients with hysterectomies before and after 1980 to assess how indications for and outcomes after hysterectomy may have changed at our institution over time. RESULTS: A total of 98 patients were identified to have undergone hysterectomy for GTN. In the entire cohort 85% (n= 83) achieved remission and 48% (n= 47) required chemotherapy after hysterectomy. Among the patients in the early cohort (n=49), indications for hysterectomy included 15 (31%) for primary definitive management, 14 (29%) for chemotherapy resistant disease, 14 (29%) for bleeding and 6 (11%) for other reasons. Of the patients with hysterectomy for chemotherapy resistance, 9 (64%) achieved remission. In the more recent cohort (n = 49) indications for hysterectomy included 24 (49%) for primary definitive management, 19 (39%) for drugresistant disease, 4 (8%) for bleeding and 2 (4%) for other reasons. Of the patients with hysterectomy for chemotherapy resistance, 16 (84%) achieved remission. There was a statistically significant decline in the number of hysterectomies performed for bleeding. Hysterectomy was performed for bleeding in the early cohort (1959-1980) in 14 (29%) of 49 patients but in only 4 (8%) of 49 patients in the later cohort (1981-2009) (p=0.02). CONCLUSION: During the years 1959-2009 the number of hysterectomies performed for GTN at the NETDC has remained stable. However, at our center there has been a decline in the incidence of hysterectomy for lifethreatening hemorrhage. Overall 83 (84.7%) patients with hysterectomy for GTN obtained remission. In pa-tients who underwent hysterectomy to treat chemotherapyresistant disease, 25 of 33 (75.8%) subsequently achieved complete remission. Hysterectomy continues to play an important role in the management of selected patients with GTN.

AB - OBJECTIVE: To identify indications for hysterectomy in patients with gestational trophoblastic neoplasia (GTN) and to evaluate outcomes of hysterectomy in those patients. STUDY DESIGN: Patients who underwent hysterectomy were identified utilizing hospital medical records and the New England Trophoblastic Disease Center (NETDC) database from January 1, 1959-January 1, 2009. Demographic data as well as indication for hysterectomy, stage, World Health Organization score, chemotherapeutic regimens and outcomes were recorded. We further stratified our population into patients with hysterectomies before and after 1980 to assess how indications for and outcomes after hysterectomy may have changed at our institution over time. RESULTS: A total of 98 patients were identified to have undergone hysterectomy for GTN. In the entire cohort 85% (n= 83) achieved remission and 48% (n= 47) required chemotherapy after hysterectomy. Among the patients in the early cohort (n=49), indications for hysterectomy included 15 (31%) for primary definitive management, 14 (29%) for chemotherapy resistant disease, 14 (29%) for bleeding and 6 (11%) for other reasons. Of the patients with hysterectomy for chemotherapy resistance, 9 (64%) achieved remission. In the more recent cohort (n = 49) indications for hysterectomy included 24 (49%) for primary definitive management, 19 (39%) for drugresistant disease, 4 (8%) for bleeding and 2 (4%) for other reasons. Of the patients with hysterectomy for chemotherapy resistance, 16 (84%) achieved remission. There was a statistically significant decline in the number of hysterectomies performed for bleeding. Hysterectomy was performed for bleeding in the early cohort (1959-1980) in 14 (29%) of 49 patients but in only 4 (8%) of 49 patients in the later cohort (1981-2009) (p=0.02). CONCLUSION: During the years 1959-2009 the number of hysterectomies performed for GTN at the NETDC has remained stable. However, at our center there has been a decline in the incidence of hysterectomy for lifethreatening hemorrhage. Overall 83 (84.7%) patients with hysterectomy for GTN obtained remission. In pa-tients who underwent hysterectomy to treat chemotherapyresistant disease, 25 of 33 (75.8%) subsequently achieved complete remission. Hysterectomy continues to play an important role in the management of selected patients with GTN.

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