Mortality factors in high and ultra-high-risk gestational trophoblastic neoplasia at moi teaching & referral hospital: A decade-long observation in kenya

Abstract

GTN refers to persistent or malignant disorders originating from the abnormal proliferation of trophoblastic tissue, which may occur subse- quent to a hydatidiform mole or a nonmolar pregnancy (Lurain, 2011). An accurate determination of the global prevalence of GTN remains a challenge due to inconsistencies in data reporting across different re- gions. Analysis of cancer registries in Africa indicated an average inci- dence of 0.38 cases per 100,000 women of reproductive age (Grimes, 1984) (Singh et al., 2021). Patients diagnosed with GTN are typically categorized into risk groups according to the prognostic scoring system established by the World Health Organization (WHO): low risk (with a score of 0 to 6), high risk (with a score of 7 to 12), and ultrahigh risk (with a score ≥ 13) (Figo Oncology Committee, 2002). This system takes into account eight risk factors that predict the potential for developing resistance to single- agent chemotherapy with methotrexate (MTX) or actinomycin D (Act D). Low-risk patients exhibit an almost 100 % overall survival (OS) rate, whereas high-risk patients experience a survival rate ranging from 80 % to 90 % (Lurain, 2011). A score of ≥ 13 is associated with a heightened risk of early mortality, leading to recommendations for managing these patients in highly specialized GTN centers. High-risk GTN cases often originate from a normal pregnancy rather than a hydatidiform mole and are frequently linked to lung metastases and, occasionally, metastases to the brain and liver (Bolze et al., 2016). Historically, prior to the introduction of effective chemotherapy regimens, GTN was almost invariably fatal. However, advances in chemotherapeutic agents for treatment have dramatically transformed GTN into a highly curable disease. Despite these advances in the management of GTN, the burden of disease and outcomes from LMICs remain a concern, as mortality data are sparse. The development of strategies for improving GTN care in this setting is therefore a challenge. The inadequacies of healthcare infra- structure and poor accessibility to specialized GTN care could contribute to disparities in treatment outcomes in LMICs compared to those in the Global North. The objective of this study was to determine the proportion of mortality in GTN patients and identify factors contributing to treatment failure over a 10-year period at the second largest tertiary healthcare facility in Kenya. This analysis seeks to highlight deficiencies in the management of GTN within a low-resource setting and provide valuable insights into areas requiring improvement.