L.A. Meshcheryakova, A.F. Maslennikov, V.V. Kuznetsov, M.A. Chekalova, I.Yu. Davydova, A.A. Mescheryakov
N.N. Blokhin National Medical Research Centre of Oncology, N.N. Trapeznikov Research Institute of Clinical Oncology, Moscow
Maslennikov Alexandr F. ― Postgraduate student of the Oncological Department of Surgical Methods of Treatment №8 (gynecological oncology) of the N.N. Blokhin National Medical Research Centre of Oncology, N.N. Trapeznikov Research Institute of Clinical Oncology
24 Kashirskoye Highway, Moscow, Russian Federation, 115478, e-mail: firstname.lastname@example.org, orcid.org/0000-0003-3959-3133
Objective ― to evaluate the role of surgical intervention in patients with malignant trophoblastic tumors (MTT) performed before the start of standard chemotherapy.
Material and methods. This study presents an analysis of 529 case histories of patients treated at the N.N. Blokhin National Medical Research Centre of Oncology in the period from 1996 to 2019. 75 of them were preceded by various surgical interventions performed at other hospitals in an emergency (due to bleeding from a tumor) or planned (more often due to clinical errors) procedure. The staging was carried out in accordance with the classification of FIGO (WHO), 2003. Revision of morphological preparations ― in accordance with the International histological classification of 2013.
The treatment of all patients in the Oncology Research Center was started with standard chemotherapy regimens in accordance with the risk of resistance to MTT according to FIGO classification, 2003.
The results of the study. The average age of patients in the study group was 35.7 years. Indications for surgical intervention were as follows: detection of a «tumor» ― 48%, bleeding ― 36%, organ perforation ― 11%, «tumor resistance to chemotherapy» ― 4%, ectopic pregnancy ― 1,3%, initially undetected tumor focus ― 1,3%
In 61% of cases, patients underwent hysterectomy in various modifications, in 11.7% ― adnex and tubectomy, uterine tumorectomy in 7%, excision of the «tumor» of the vagina ― 1.3%, in 12% ― lung surgery (from resection lobes before pulmonectomy), nephrectomy ― 4%, craniotomy, liver resection ― 2.7% each, splenectomy ― 1.3%.
In a comparative analysis of the prevalence of the tumor process in patients who underwent surgical intervention at the first stage of treatment and patients whose treatment was started with chemotherapy, it was established: in the group of operated patients, stage I disease was diagnosed only in 21.3% of cases, in 78.7% disseminated disease. In the comparison group, stage I was established in 66.5% of cases, and disseminated disease ― only in 33.5%, which is 2.4 times lower than in patients operated before chemotherapy. At the same time, the worst prognosis (IV stage of MTT) in the study group was found at 34.7%, and in the comparison group ― only at 2.4% of observations, which is 14.5 times higher.
A high risk of resistance and the need for combined chemotherapy in the study group were recorded in 64%, which is 2.6 times higher than in the group without operations (25%).
As a result of the treatment, it was found that the frequency of MTT resistance in the study group was slightly higher than in the comparison group (17.3% versus 13%). The relapse rate in the study group was 3.6 times higher (16% versus 4.9%).
Mortality in the study group was 5.3%, which is 4.8 times higher than in the comparison group (1.1%).
Conclusion. The negative consequences of surgical interventions in patients with MTT are obvious before the start of standard chemotherapy. The high aggressiveness of MTT, the postponement of vital chemotherapy, the rapid spread of the tumor, worsens the course of the disease and prognosis. Only treatment in a highly specialized center with great positive experience allowed us to achieve high results, despite the worst prognosis in the analyzed group.
Key words: trophoblastic disease, trophoblastic tumor, surgical treatment of trophoblastic tumors, hydatidiform mole.