Determinants of Gestational Trophoblastic Neoplasia in Rwanda Retrospective Cohort Study

Abstract

Background: Gestational trophoblastic neoplasia (GTN) is rare disease affecting reproductive age women. It includes a spectrum of malignant neoplasms due to abnormal development of trophoblastic tissues of the plaenta. GTN in Rwanda is not well studied. The aim of this study was to determine patient and disease characteristics of the women with GTN who were followed at a major university hospital in Kigali Rwanda.

Methods: This was retrospective cohort study of women diagnosed with GTN at Kigali University Teaching Hospital (CHUK) between July 2015 and July 2020. Data were extracted from the GTN Database, a disease registry, with additional data retrieved from the patient file as needed. Information collected included: nationality, residence, maternal age, gestational event leading to GTN, pathologic diagnosis if available, FIGO stage and WHO score, number of chemotherapy cycles completed and clinical outcome. Descriptive statistics were calculated for all variables. Chi square and Exact Fisher test were used for measure of association and a P value of <0.05 was considered significant.

Results: The majority of patients were diagnosed with low-risk disease (78.4%). The most common type of GTN was post-molar (86.5%) and 67.6% of women had disease confined to the uterus. Hysterectomy was performed for 40 (54%) women as part of their management for GTN. Patients who underwent hysterectomy, compared to those with a preserved uterus, had shorter treatment duration median (45 days vs 115 days) and received fewer chemotherapy cycles (median 2 cycle’s vs 4.5 cycles). The cure rate among patient followed at CHUK was 84.8% and 9.1%

failed single agent chemotherapy with referral for additional chemotherapy and 6.1% died.

Conclusion: The majority of GTN patients treated CHUK successfully achieved remission at the rate of 84.8 %. However, one third of all patients with GTN in this study had an undocumented outcome; there is an opportunity to improve documentation and patient surveillance. There is a need for an innovative follow up plan, especially post hysterectomy.