Gestational trophoblastic neoplasia with pancreatic metastasis: clinical characteristics, treatment strategies, and outcomes.

Abstract

Objective: Pancreatic metastasis of gestational trophoblastic neoplasia (GTN) is extremely rare, with only a few reported cases.

Methods: A retrospective analysis was conducted on GTN patients with pancreatic metastasis at Peking Union Medical College Hospital (2000-2024) and a literature review was performed. A descriptive analysis was carried out on the clinical characteristics, treatment strategies, and outcomes of patients who met the inclusion criteria. Fisher's exact test was used to analyze differences in metastatic patterns and clinical outcomes among patients with different clinical characteristics.

Results: A total of 24 cases were identified (7 from our institute, 17 from literature): 18 choriocarcinomas, 5 placental-site trophoblastic tumors, and 1 epithelioid trophoblastic tumor. Pancreatic metastasis led to organ-specific symptoms. Treatments included chemotherapy (single/multi-agent), immunotherapy, and targeted therapy. Six patients underwent surgical or localized interventions. Outcomes varied: 9 (37.5%) achieved disease-free survival, 5 (20.8%) had partial remission, and 10 (41.7%) died. Surgical or invasive interventions were associated with significantly improved outcomes (P = 0.024).

Conclusion: Pancreatic invasion in GTN is a high-risk condition often associated with poor outcomes. Advanced imaging techniques enhance diagnostic accuracy, while endoscopic ultrasound-guided fine-needle biopsy provides essential histopathological confirmation. Multi-agent chemotherapy remains the cornerstone of treatment, with surgical interventions carefully tailored to the individual patient's condition. For better management and prognosis, an initial treatment strategy integrating multi-agent chemotherapy, immunotherapy, and targeted therapies may offer benefits; however, further investigation is warranted.