Gestational trophoblastic neoplasia in adolescents

Objective: To evaluate the clinical outcomes in adolescents with gestational trophoblastic neoplasia (GTN) compared to adult women. Study Design: Patients with International Federation of Gynecology and Obstetrics criteria for GTN who underwent treatment between January 1, 1973, and December 31, 2010, were identified from the Donald P. Goldstein, M.D., Trophoblastic Tumor Registry of the New England Trophoblastic Disease Center. Adolescents included patients < 20 years old at the time of diagnosis. Standard univariate analyses were performed, as were multivariate analyses with logistic regression to control for potential confounding variables. Results: We identified 423 women with GTN; 50 (12%) patients were adolescents (< 20 years old), and 373 (88%) were ≥ 20 years old. Both groups had the same rate of low-risk GTN score (98% vs. 98%, p=0.9). In the adolescent group 47 (94%) women had stage I GTN, and 3 (6%) had stage III. In the adult group 304 (81.5%) women had stage I GTN, 4 (1%) had stage II, 64 (17%) had stage III and only 1 (0.5%) had stage IV disease (p= 0.7). Adolescents at molar presentation had higher rates of anemia (30% vs. 14%, p=0.001), vaginal bleeding (86% vs. 67%, p=0.001), and a uterus with size greater than dates (42% vs. 24%, p= 0.007). Factors determined to significantly influence resistance to initial chemotherapeutic treatment on multivariate analysis were β-hCG level at molar presentation > 100,000 mIU/mL, β-hCG level at persistence > 20,000 mIU/mL, the presence of metastasis, and duration of disease > 4 months. Age < 20 years old was not a prognostic factor of resistance to initial chemotherapeutic treatment. Conclusion: There was no difference between adolescents and adult women in the rates of low-risk GTN, stage of GTN, and the frequency of resistance to initial chemotherapeutic treatment.