Department of Gynaecologic Oncology, Centre of Gynaecologic Oncology Amsterdam, Amsterdam, The Netherlands
Department of Gynaecologic Oncology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Int J Gynecol Cancer. 2019 Jan;29(1):108-112. doi: 10.1136/ijgc-2018-000028.
Because gestational trophoblastic disease is rare, little evidence is available from randomized controlled trials on optimal treatment and follow-up. Treatment protocols vary within Europe, and even between different centers within countries. One of the goals of the European Organization for Treatment of Trophoblastic Diseases (EOTTD) is to harmonize treatment in Europe. To provide a basis for international standardization of definitions, treatment and follow-up protocols in gestational trophoblastic disease, we evaluated differences and similarities between protocols in EOTTD countries.
Members from each EOTTD country were asked to complete an online structured questionnaire comprising multiple-choice and multiple-answer questions. The following themes were discussed: incidence of gestational trophoblastic disease and gestational trophoblastic neoplasia, definitions, guidelines, classification system, treatment, recurrence, and follow-up.
Forty-four respondents from 17 countries participated in this study. Guidelines were present in 80% of the countries and the FIGO (Fédération Internationale de Gynécologie et d'Obstétrique) staging and risk classification was often used to estimate risks. Agreement about when to start chemotherapy for post-molar gestational trophoblastic neoplasia was present among 66% of the respondents. Preferred first-line treatments in low- and high-risk gestational trophoblastic neoplasia were methotrexate (81%) and EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) (93%), respectively. The definition of human chorionic gonadotropin normalization after hydatidiform mole evacuation was two consecutive normal values for nine countries. The FIGO definition of post-molar gestational trophoblastic neoplasia based on human chorionic gonadotropin plateau or rise was agreed on by 69% of respondents, and only 69% and 74% defined low-risk and high-risk disease, respectively, using FIGO criteria. There were major differences in definitions of recurrence, chemotherapy resistance and follow-up protocols among countries, despite EOTTD consensus statements.
This questionnaire provides a good overview of current clinical practices in different countries. Based on the survey results, it is clear that there are several gestationaltrophoblastic disease-related topics that need urgent attention within the EOTTD community to create more uniformity and to aid the development of uniform guidelines in Europe.
由于妊娠滋养细胞疾病罕见，因此在随机对照试验中关于最佳治疗和随访的证据很少。在欧洲，治疗方案各不相同，甚至在同一国家的不同中心之间也存在差异。欧洲滋养细胞疾病治疗组织（EOTTD）的目标之一是协调欧洲的治疗方法。为了为妊娠滋养细胞疾病的定义、治疗和随访方案提供国际标准化的基础，我们评估了 EOTTD 国家之间方案的异同。
要求 EOTTD 每个国家的成员填写一份在线结构化问卷，其中包含多项选择题和多项选择题。讨论的主题包括：妊娠滋养细胞疾病和妊娠滋养细胞肿瘤的发生率、定义、指南、分类系统、治疗、复发和随访。
来自 17 个国家的 44 名受访者参加了这项研究。80%的国家都有指南，FIGO（国际妇科肿瘤学联合会）分期和风险分类常用于评估风险。对于何时开始治疗葡萄胎后妊娠滋养细胞肿瘤，66%的受访者表示存在一致性意见。低危和高危妊娠滋养细胞肿瘤的首选一线治疗方法分别为甲氨蝶呤（81%）和 EMA-CO（依托泊苷、甲氨蝶呤、放线菌素 D、环磷酰胺、长春新碱）（93%）。对于葡萄胎排空后人绒毛膜促性腺激素正常化的定义，9 个国家采用连续两次正常值。对于基于人绒毛膜促性腺激素平台或升高的葡萄胎后妊娠滋养细胞肿瘤的 FIGO 定义，69%的受访者表示同意，而仅 69%和 74%分别使用 FIGO 标准定义低危和高危疾病。尽管有 EOTTD 共识声明，但各国之间在复发、化疗耐药和随访方案等方面仍存在重大差异。
该问卷很好地概述了不同国家的当前临床实践。根据调查结果，很明显，EOTTD 社区需要关注几个与妊娠滋养细胞疾病相关的问题，以实现更大的统一性，并帮助制定欧洲统一指南。
