GTN misdiagnosed as ectopic pregnancy: a 17-year retrospective cohort study

IF 4.1 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-06-13 DOI:10.1016/j.ygyno.2025.06.010

Yuanyuan Liu , Yusen Zhou , Ziying Zhou , Xuan Rao , Liang Feng , Weiguo Lu , Xiao Li

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引用次数: 0

Abstract

Objective

To evaluate the effect of misdiagnosis on the chemotherapy response and prognosis of gestational trophoblastic neoplasia (GTN), and to explore strategies to enhance precision management of uncertain GTN.

Methods

GTN patients misdiagnosed as ectopic pregnancies were retrospectively enrolled. GTN without misdiagnosis were randomly selected as control group at a 1:1 ratio, matching by age, WHO risk score and admission year. All patients were followed up for pregnancy, recurrence, and survival. Mann-Whitney test was used for continuous variables. Categorical variables were assessed using the Chi-square test or Fisher's exact test.

Results

Among 35 misdiagnosed cases, high-risk GTN accounted for 57.1 %. Antecedent nonmolar pregnancy in misdiagnosed group was 88.6 %. Pretreatment human chorionic gonadotropin (hCG) was lower (3477 vs 18,121 IU/L) while recurrence rate was significantly higher in misdiagnosed group than in control group (28.6 % vs 5.7 %, p = 0.011). The resistance rate showed an increasing trend in misdiagnosed group (22.9 % vs 14.3 %, p = 0.356). For subgroup analysis, the resistance rate was increased in group A (treated with methotrexate) than group B (without methotrexate), while decreased in patients with lesion resection (group C) than without resection (group D), especially for low-risk patients. Histopathological misdiagnosis for antecedent pregnancy and GTN in primary hospitals were 2 and 6 cases respectively.

Conclusions

GTN after nonmolar pregnancy with low hCG are prone to be misdiagnosed, which might lead to increased WHO risk scores, resistance, and relapse rates. Surgical intervention, especially lesion resection instead of methotrexate, is recommended for atypical GTN.

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GTN误诊为异位妊娠：一项17年回顾性队列研究

目的评价误诊对妊娠滋养细胞瘤（GTN）化疗反应及预后的影响，探讨加强不确定GTN精准管理的对策。方法回顾性分析误诊为异位妊娠的sgtn患者。按年龄、WHO风险评分、入院年份匹配，按1:1比例随机选择无误诊的GTN作为对照组。随访所有患者的妊娠、复发及生存情况。对连续变量采用Mann-Whitney检验。使用卡方检验或Fisher精确检验评估分类变量。结果35例误诊病例中，高危GTN占57.1%。误诊组既往非磨牙妊娠占88.6%。预处理组人绒毛膜促性腺激素（hCG）低于对照组（3477 vs 18121 IU/L），复发率显著高于对照组（28.6% vs 5.7%, p = 0.011）。误诊组耐药率呈上升趋势（22.9% vs 14.3%, p = 0.356）。在亚组分析中，A组（甲氨蝶呤治疗）的耐药率高于B组（未加甲氨蝶呤治疗），而病变切除（C组）的耐药率低于未加切除（D组），尤其是低危患者。基层医院组织病理学误诊既往妊娠和GTN分别为2例和6例。结论低hCG的非磨牙妊娠后sgtn易误诊，可能导致WHO风险评分增高、耐受性增高、复发率增高。对于非典型GTN，建议采用手术治疗，尤其是病变切除而非甲氨蝶呤治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy