Treatment Outcomes and Resistance Patterns in Low Risk GTN: A 270-Patient Experience from a Tertiary Center

Because of the lack of fully successful treatment of low-risk gestational trophoblastic neoplasia (GTN) patients after first-line single-agent chemotherapy, some studies have suggested that these patients should be treated with multi-drug chemotherapy from the outset. A score of 0-4 represents the majority of low risk GTN that has been less studied. The present study aimed to investigate the risk factors associated with resistance to first-line single-agent chemotherapy. This retrospective cohort includes patients diagnosed with low-risk GTN who were treated with single-agent chemotherapy using methotrexate and actinomycin. Factors associated with resistance to first-line chemotherapy were analyzed separately in two groups: those with a score of 0-6 and those with a score of 0-4. A total of 270 patients were studied, all of whom achieved remission. Of these, 75.9% responded to first-line single-agent chemotherapy. Patients aged 40 or older had about 7 times higher odds of treatment resistance than younger patients. Choriocarcinoma increased the odds by 5.5 times, and each 1 cm increase in tumor size raised the odds by 53%. In patients with WHO scores of 0-4, each additional year of age increased resistance odds by 6%, and choriocarcinoma raised it by 7.5 times. In both groups, lung metastasis increased the chance of resistance threefold. Increased age, larger tumor size, increase βhCG level and start of treatment with MTX, increase the likelihood of resistance to first-line chemotherapy in the 0-6 score and in the subgroup with a 0-4 score. Future prospective studies are necessary to validate new models Until then, clinicians should be aware of the limitations of the current system and consider individualized clinical judgment.