Clinical experience with de-escalated chemotherapy for a subset of high-risk gestational trophoblastic neoplasia at a...

The FIGO scoring system is a well-established method for classifying patients with gestational trophoblastic neoplasia (GTN) worldwide, and the Japanese scoring system is widely employed in Japan. This study aimed to evaluate the clinical outcomes of de-escalated chemotherapy in patients with high-risk GTN, classified as "clinical invasive mole" according to the Japanese scoring system.

We retrospectively reviewed 268 patients with GTN who received initial treatment at Nagoya University Hospital between 1991 and 2023. All patients were assessed using the FIGO and Japanese scoring systems, and treatment strategies were determined primarily based on histopathological diagnosis and subsequently guided by the Japanese scoring system. Clinical features and treatment outcomes were analyzed.

Among 268 patients, 49 were classified as having high-risk GTN. All patients with FIGO scores of ≥ 9 were classified as "clinical choriocarcinoma" by the Japanese scoring system. In contrast, 17 patients with FIGO scores of 7-8 were divided into the invasive mole group (n = 7) and the choriocarcinoma group (n = 10). All patients in the invasive mole group received de-escalated chemotherapy and achieved complete remission. The proportions of patients with age ≥ 40 years (p = 0.046), antecedent hydatidiform mole (p = 0.021), shorter interval from index pregnancy (p = 0.002), and larger tumor size (p = 0.003) were significantly higher in the invasive mole group than in the choriocarcinoma group.

De-escalated chemotherapy may be feasible for select patients with FIGO scores of 7-8, and further refinement of risk stratification is warranted to avoid overtreatment.