Przewlekła choroba trofoblastyczna i choriokarcynoma
Rokowania, prognozy i postęp choroby

Przewlekła choroba trofoblastyczna (GTN) oraz choriokarcinoma cechują się bardzo dobrym rokowaniem, z niemal 100% wskaźnikiem wyleczeń przy odpowiednim leczeniu, co czyni je jednymi z najlepiej rokujących nowotworów złośliwych. Kluczowym narzędziem w ocenie rokowania i planowaniu terapii jest system prognostyczny FIGO 2000, z aktualizacją z 2015 roku wprowadzającą kategorię ultra wysokiego ryzyka (wynik FIGO ≥12), co poprawiło precyzję klasyfikacji pacjentek z rozległymi przerzutami. Pacjentki dzielone są na trzy grupy ryzyka: niskie (wynik ≤6) z 100% przeżywalnością, wysokie (wynik ≥7) z przeżywalnością powyżej 90% w ośrodkach specjalistycznych oraz ultra wysokie ryzyko, gdzie wskaźnik wyleczeń wynosi około 75%. Retrospektywna analiza wykazała 5-letnią śmiertelność 38,4% u pacjentek z wynikiem ≥13, podkreślając znaczenie dokładnej stratyfikacji ryzyka.

  1. Prognostyka przewlekłej choroby trofoblastycznej i choriokarcynomy
    1. Systemy oceny prognostycznej
    2. Kategorie ryzyka i ich rokowanie
    3. Czynniki wpływające na rokowanie
    4. Rokowanie w przypadku nawrotów i oporności na chemioterapię
    5. Przypadki szczególne i wyjątkowe
    6. Ograniczenia obecnych systemów prognostycznych
  2. Wnioski końcowe
    1. Kolejne rozdziały

Prognostyka przewlekłej choroby trofoblastycznej i choriokarcynomy

Przewlekła choroba trofoblastyczna i choriokarcynoma (nowotworowa choroba trofoblastyczna, GTN) charakteryzują się generalnie bardzo dobrym rokowaniem. Niemal wszystkie pacjentki zostają wyleczone dzięki odpowiedniemu leczeniu, co czyni te schorzenia jednymi z nielicznych nowotworów złośliwych o tak wysokim wskaźniku wyleczeń12. Pomimo złośliwego charakteru, zwłaszcza choriokarcynoma, które jest wysoce inwazyjnym nowotworem i potencjalnie zagrażającym życiu schorzeniem, wykazuje wyjątkową wrażliwość na chemioterapię3.

Systemy oceny prognostycznej

Głównym narzędziem używanym do prognostyki i planowania leczenia jest System Prognostyczny FIGO 2000, który stanowi globalny standard oceny rokowania u pacjentek z GTN, szczególnie z inwazyjnym zaśniadem groniastym i choriokarcynomą4. Podobnie używany jest system prognostyczny Światowej Organizacji Zdrowia (WHO), który pomaga zespołowi medycznemu w określeniu planu leczenia i rokowania dla nowotworowej postaci GTD5.

W 2015 roku wprowadzono ważną aktualizację systemu FIGO 2000, dodając kategorię ultra wysokiego ryzyka, co zwiększyło dokładność prognostyczną systemu poprzez lepsze dopasowanie wyników punktacji do rzeczywistych wyników leczenia6. Ta zmiana była istotna dla precyzyjnej klasyfikacji pacjentek z wynikami FIGO ≥12 lub z rozległymi przerzutami7.

Kategorie ryzyka i ich rokowanie

W oparciu o systemy prognostyczne, pacjentki z GTN dzielone są na trzy główne kategorie ryzyka, które determinują zarówno strategię leczenia, jak i rokowanie8:

  • Niskie ryzyko (wynik prognostyczny ≤6) – charakteryzuje się doskonałym rokowaniem, z odsetkiem wyleczeń sięgającym 100%. Nowotwór w tej grupie zwykle dobrze reaguje na leczenie, a wysoka przeżywalność utrzymuje się nawet w przypadkach z przerzutami91011.
  • Wysokie ryzyko (wynik prognostyczny ≥7) – może wymagać bardziej intensywnego lub odmiennego schematu leczenia niż przypadki niskiego ryzyka. Niemniej jednak, przy odpowiednim leczeniu, wszystkie pacjentki (100%) z chorobą wysokiego ryzyka są z powodzeniem leczone1213. W specjalistycznych ośrodkach, współczynnik przeżywalności przekracza 90%14.
  • Ultra wysokie ryzyko – najcięższa postać choroby, charakteryzująca się najwyższymi wynikami w skali FIGO lub rozległymi przerzutami. Około 75% pacjentek z chorobą ultra wysokiego ryzyka zostaje pomyślnie wyleczonych15.

Czynniki wpływające na rokowanie

Retrospektywna analiza z 2016 roku przeprowadzona przez Bolze i współpracowników wykazała znaczącą pięcioletnią śmiertelność na poziomie 38,4% u 29 pacjentek z wynikami ≥13, w porównaniu do śmiertelności 4,9% u pacjentek wysokiego ryzyka z wynikami 7-1216. Obserwacja ta podkreśla znaczenie właściwej stratyfikacji ryzyka, zwłaszcza w najcięższych przypadkach.

Badania wykazały również, że rokowanie w dużej mierze zależy od statusu choroby w momencie diagnozy17. W przypadku choroby niemetastatycznej, wskaźnik wyleczeń zbliża się do 100% przy zastosowaniu chemioterapii18. Podobnie, metastatyczna choroba niskiego ryzyka ma wskaźnik wyleczeń zbliżony do 100%19.

Rokowanie w przypadku nawrotów i oporności na chemioterapię

Ogólny wskaźnik 5-letniego przeżycia u pacjentek z nawrotową GTN wynosi 93% (95% CI 86-100%)20. Przeżywalność jest różna w zależności od początkowej kategorii ryzyka:

  • Dla pacjentek z chorobą niskiego ryzyka przy pierwszej diagnozie, które później doświadczyły nawrotu, wskaźnik przeżycia wynosi 100% (n=35)21.
  • Dla pacjentek z chorobą wysokiego ryzyka przy prezentacji, które następnie doświadczyły nawrotu, wskaźnik przeżycia wynosi 84% (95% CI: 66-96%, P≤0.05) (n=25)22.

Prawdopodobieństwo późnego nawrotu po tym, jak pacjentka osiągnęła remisję (normalne miano beta-hCG w surowicy) przez okres 1 roku, wynosi mniej niż 1%23.

Warto zauważyć, że rokowanie dla pacjentek z chorobą oporną na chemioterapię (chemo-refractory) jest mniej korzystne niż dla pacjentek z nawrotami po początkowej odpowiedzi na leczenie24. Dla tej grupy pacjentek potrzebne są nowe, innowacyjne metody terapeutyczne25.

Przypadki szczególne i wyjątkowe

W literaturze opisano przypadki pacjentek z bardziej zaawansowaną i rzadką postacią choroby. Na przykład, pacjentka z nabłonkowym guzem trofoblastycznym (epithelioid trophoblastic tumor) z miejscowo zaawansowaną chorobą, zajęciem szyjki macicy i pochwy, licznymi przerzutami do płuc oraz wysokim poziomem hCG w surowicy (514,967 mUI/ml) stanowiła wyzwanie terapeutyczne. Pomimo agresywnego charakteru choroby, po leczeniu osiągnięto obniżenie poziomu hCG do <5 U/ml, a badania obrazowe (PET/CT, CT i MRI mózgu) wykazały ustąpienie zmian przerzutowych26.

Ograniczenia obecnych systemów prognostycznych

Pomimo powszechnego wykorzystania systemu FIGO 2000, badania wykazały pewne ograniczenia w jego zdolności do dokładnej oceny ryzyka nawrotu27. Wprowadzenie kategorii ultra wysokiego ryzyka, choć stanowi istotny postęp, stawia przed systemem FIGO znaczące wyzwanie w zakresie precyzyjnego przewidywania odpowiedzi na leczenie, wskaźników nawrotów czy śmiertelności w ramach kompleksowych ram punktacji28.

Istnieją kluczowe czynniki ryzyka, które nadal nie są uwzględnione w obecnych systemach oceny prognostycznej, co podkreśla obszar możliwych ulepszeń w przyszłości29.

Wnioski końcowe

Przewlekła choroba trofoblastyczna i choriokarcynoma charakteryzują się generalnie bardzo dobrym rokowaniem, z niemal wszystkimi pacjentkami całkowicie wyleczonymi dzięki odpowiedniemu leczeniu3031. Tylko nieliczne kobiety z GTD mają złe rokowanie, np. niektóre formy GTN w IV stadium32.

Bardzo istotne jest wczesne wykrycie złośliwych form GTD33. W ostatnich latach obserwuje się poprawę we wczesnym wykrywaniu choriokarcynomy, co znacząco obniżyło wskaźnik śmiertelności również w krajach rozwijających się34.

Pomimo ogólnie doskonałego rokowania, nadal istnieje potrzeba doskonalenia systemów prognostycznych oraz opracowywania nowych strategii terapeutycznych dla pacjentek z chorobą oporną na standardowe leczenie3536.

Pacjentki, które przeszły leczenie z powodu GTN i zachowały płodność, mogą spodziewać się wyników położniczych zbliżonych do populacji ogólnej w przypadku późniejszych ciąż3738. Jest to dodatkowy, niezwykle istotny aspekt dobrego rokowania w tej grupie chorych.

Kolejne rozdziały

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  1. 16.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Survival for invasive mole and choriocarcinoma | Gestational trophobastic disease (GTD) | Cancer Research UK
    https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/survival
    Survival for invasive mole and choriocarcinoma is very high. Nearly all women are cured. […] Chemotherapy works very well for most women with invasive mole or choriocarcinoma. Those who need chemotherapy are divided into 3 different risk groups – low risk, high risk and ultra high risk disease. […] All women (100%) with low risk disease are successfully treated. […] All those (100%) with high risk disease are successfully treated. […] Around three quarters (75%) of those with ultra high risk disease are successfully treated.
  • #2 Invasive mole and choriocarcinoma | Gestational trophoblastic disease (GTD) | Cancer Research UK
    https://www.nhs.uk/conditions/persistent-trophoblastic-disease-choriocarcinoma/
    Survival for invasive mole and choriocarcinoma is very high. Nearly all women are cured. […] The stage of an invasive mole or choriocarcinoma tells you how far it has spread. Your doctors will look at this and other risk factors to plan your treatment.
  • #3 Gestational trophoblastic disease – Wikipedia
    https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease
    Choriocarcinoma, for example, is an uncommon, yet almost always curable cancer. Although choriocarcinoma is a highly malignant tumour and a life-threatening disease, it is very sensitive to chemotherapy. Virtually all women with non-metastatic disease are cured and retain their fertility; the prognosis is also very good for those with metastatic (spreading) cancer, in the early stages, but fertility may be lost. […] Women with a hydatidiform mole have an excellent prognosis. Women with a malignant form of GTD usually have a very good prognosis. […] The risk can be estimated by scoring systems such as the Modified WHO Prognostic Scoring System, wherein scores between 1 and 4 from various parameters are summed together. […] It is very important for malignant forms of GTD to be discovered in time. […] There have been improvements in these countries in the early detection of choriocarcinoma, thereby significantly reducing the mortality rate also in developing countries. […] Only a few women with GTD have a poor prognosis, e.g. some forms of stage IV GTN.
  • #4 Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11582452/
    The FIGO 2000 Prognostic Scoring System is a global standard for prognostication in patients with gestational trophoblastic neoplasia (GTN). […] The FIGO 2000 system, recognized globally, sets the standard for evaluating the prognosis and clinical status of patients with GTN, particularly those with invasive mole and choriocarcinoma. […] The 2015 update introduced an ultra-high-risk category, enhancing the system’s prognostic accuracy by aligning scores more closely with outcomes. […] The inclusion of treatment modalities other than single-agent chemotherapy calls the reliability of FIGO 2000 for assessing single-agent chemotherapy success rates into question. […] The introduction of an ultra-high-risk category in FIGO 2000 was a significant development that addressed the precise classification of patients with FIGO scores 12 or those with extensive metastasis.
  • #5 Prognosis and survival for gestational trophoblastic disease | Canadian Cancer Society
    https://cancer.ca/en/cancer-information/cancer-types/gestational-trophoblastic-disease/prognosis-and-survival
    A prognosis is the doctors best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors. […] The World Health Organization (WHO) prognostic scoring system is a tool that may help your healthcare team determine your treatment plan and prognosis for cancerous GTD. This scoring system applies to invasive mole and gestational choriocarcinoma. […] Low-risk cancerous GTD has a prognostic score of 6 or less. It often responds well to treatment and has a very high survival rate. Low-risk cancerous GTD tends to have a good prognosis even if it has spread. […] High-risk cancerous GTD has a prognostic score of 7 or more. It may not respond to treatment as well as low-risk cancerous GTD does, so it may need more or different treatments. High-risk cancerous GTD that hasnt spread has a good prognosis. High-risk GTD that has spread is usually successfully treated too.
  • #6 Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11582452/
    The FIGO 2000 Prognostic Scoring System is a global standard for prognostication in patients with gestational trophoblastic neoplasia (GTN). […] The FIGO 2000 system, recognized globally, sets the standard for evaluating the prognosis and clinical status of patients with GTN, particularly those with invasive mole and choriocarcinoma. […] The 2015 update introduced an ultra-high-risk category, enhancing the system’s prognostic accuracy by aligning scores more closely with outcomes. […] The inclusion of treatment modalities other than single-agent chemotherapy calls the reliability of FIGO 2000 for assessing single-agent chemotherapy success rates into question. […] The introduction of an ultra-high-risk category in FIGO 2000 was a significant development that addressed the precise classification of patients with FIGO scores 12 or those with extensive metastasis.
  • #7 Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11582452/
    The FIGO 2000 Prognostic Scoring System is a global standard for prognostication in patients with gestational trophoblastic neoplasia (GTN). […] The FIGO 2000 system, recognized globally, sets the standard for evaluating the prognosis and clinical status of patients with GTN, particularly those with invasive mole and choriocarcinoma. […] The 2015 update introduced an ultra-high-risk category, enhancing the system’s prognostic accuracy by aligning scores more closely with outcomes. […] The inclusion of treatment modalities other than single-agent chemotherapy calls the reliability of FIGO 2000 for assessing single-agent chemotherapy success rates into question. […] The introduction of an ultra-high-risk category in FIGO 2000 was a significant development that addressed the precise classification of patients with FIGO scores 12 or those with extensive metastasis.
  • #8 Survival for invasive mole and choriocarcinoma | Gestational trophobastic disease (GTD) | Cancer Research UK
    https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/survival
    Survival for invasive mole and choriocarcinoma is very high. Nearly all women are cured. […] Chemotherapy works very well for most women with invasive mole or choriocarcinoma. Those who need chemotherapy are divided into 3 different risk groups – low risk, high risk and ultra high risk disease. […] All women (100%) with low risk disease are successfully treated. […] All those (100%) with high risk disease are successfully treated. […] Around three quarters (75%) of those with ultra high risk disease are successfully treated.
  • #9 Prognosis and survival for gestational trophoblastic disease | Canadian Cancer Society
    https://cancer.ca/en/cancer-information/cancer-types/gestational-trophoblastic-disease/prognosis-and-survival
    A prognosis is the doctors best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors. […] The World Health Organization (WHO) prognostic scoring system is a tool that may help your healthcare team determine your treatment plan and prognosis for cancerous GTD. This scoring system applies to invasive mole and gestational choriocarcinoma. […] Low-risk cancerous GTD has a prognostic score of 6 or less. It often responds well to treatment and has a very high survival rate. Low-risk cancerous GTD tends to have a good prognosis even if it has spread. […] High-risk cancerous GTD has a prognostic score of 7 or more. It may not respond to treatment as well as low-risk cancerous GTD does, so it may need more or different treatments. High-risk cancerous GTD that hasnt spread has a good prognosis. High-risk GTD that has spread is usually successfully treated too.
  • #10 Survival for invasive mole and choriocarcinoma | Gestational trophobastic disease (GTD) | Cancer Research UK
    https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/survival
    Survival for invasive mole and choriocarcinoma is very high. Nearly all women are cured. […] Chemotherapy works very well for most women with invasive mole or choriocarcinoma. Those who need chemotherapy are divided into 3 different risk groups – low risk, high risk and ultra high risk disease. […] All women (100%) with low risk disease are successfully treated. […] All those (100%) with high risk disease are successfully treated. […] Around three quarters (75%) of those with ultra high risk disease are successfully treated.
  • #11 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/279116-overview
    Nonmetastatic GTN has a cure rate of close to 100% with chemotherapy treatment. […] Metastatic low-risk GTN has a cure rate of close to 100% with chemotherapy treatment. Metastatic high-risk GTN has a cure rate of approximately 75% with chemotherapy treatment. […] Currently, prognosis and treatment is decided using the WHO prognostic score. Patients with a WHO score of 6 or less have excellent prognosis and are initially treated with single agent chemotherapy. […] The reported cure rate for patients with low-risk disease (WHO score of 6 or less) is almost 100%. […] The survival of patients with high-risk disease (score 6) treated aggressively at specialized centers is better than 90%. […] The probability of a late recurrence after the patient has been in remission (normal serum beta-hCG titers) for 1 year is less than 1%.
  • #12 Survival for invasive mole and choriocarcinoma | Gestational trophobastic disease (GTD) | Cancer Research UK
    https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/survival
    Survival for invasive mole and choriocarcinoma is very high. Nearly all women are cured. […] Chemotherapy works very well for most women with invasive mole or choriocarcinoma. Those who need chemotherapy are divided into 3 different risk groups – low risk, high risk and ultra high risk disease. […] All women (100%) with low risk disease are successfully treated. […] All those (100%) with high risk disease are successfully treated. […] Around three quarters (75%) of those with ultra high risk disease are successfully treated.
  • #13 Prognosis and survival for gestational trophoblastic disease | Canadian Cancer Society
    https://cancer.ca/en/cancer-information/cancer-types/gestational-trophoblastic-disease/prognosis-and-survival
    A prognosis is the doctors best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors. […] The World Health Organization (WHO) prognostic scoring system is a tool that may help your healthcare team determine your treatment plan and prognosis for cancerous GTD. This scoring system applies to invasive mole and gestational choriocarcinoma. […] Low-risk cancerous GTD has a prognostic score of 6 or less. It often responds well to treatment and has a very high survival rate. Low-risk cancerous GTD tends to have a good prognosis even if it has spread. […] High-risk cancerous GTD has a prognostic score of 7 or more. It may not respond to treatment as well as low-risk cancerous GTD does, so it may need more or different treatments. High-risk cancerous GTD that hasnt spread has a good prognosis. High-risk GTD that has spread is usually successfully treated too.
  • #14 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/279116-overview
    Nonmetastatic GTN has a cure rate of close to 100% with chemotherapy treatment. […] Metastatic low-risk GTN has a cure rate of close to 100% with chemotherapy treatment. Metastatic high-risk GTN has a cure rate of approximately 75% with chemotherapy treatment. […] Currently, prognosis and treatment is decided using the WHO prognostic score. Patients with a WHO score of 6 or less have excellent prognosis and are initially treated with single agent chemotherapy. […] The reported cure rate for patients with low-risk disease (WHO score of 6 or less) is almost 100%. […] The survival of patients with high-risk disease (score 6) treated aggressively at specialized centers is better than 90%. […] The probability of a late recurrence after the patient has been in remission (normal serum beta-hCG titers) for 1 year is less than 1%.
  • #15 Survival for invasive mole and choriocarcinoma | Gestational trophobastic disease (GTD) | Cancer Research UK
    https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/survival
    Survival for invasive mole and choriocarcinoma is very high. Nearly all women are cured. […] Chemotherapy works very well for most women with invasive mole or choriocarcinoma. Those who need chemotherapy are divided into 3 different risk groups – low risk, high risk and ultra high risk disease. […] All women (100%) with low risk disease are successfully treated. […] All those (100%) with high risk disease are successfully treated. […] Around three quarters (75%) of those with ultra high risk disease are successfully treated.
  • #16 Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11582452/
    A pivotal 2016 retrospective analysis by Bolze et al. reported a notable five-year mortality rate of 38.4% in 29 patients with scores 13 compared with a 4.9% mortality rate in high-risk patients with scores of 712. […] While the ultra-high-risk category attempts to refine prognostic accuracy by closely monitoring disease progression and forecasting outcomes, it also presents the FIGO system with the considerable challenge of precisely predicting treatment responses, recurrence rates, or mortality within a comprehensive scoring framework. […] Recent studies have revealed notable deficiencies in FIGO 2000’s ability to accurately evaluate recurrence risk. […] Despite the critical nature of these risk factors, they still do not feature in the current prognostic scoring systems, underscoring a crucial area for possible improvement.
  • #17 Invasive mole and choriocarcinoma | Gestational trophoblastic disease (GTD) | Cancer Research UK
    https://www.nhs.uk/conditions/persistent-trophoblastic-disease-choriocarcinoma/
    Survival for invasive mole and choriocarcinoma is very high. Nearly all women are cured. […] The stage of an invasive mole or choriocarcinoma tells you how far it has spread. Your doctors will look at this and other risk factors to plan your treatment.
  • #18 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/279116-overview
    Nonmetastatic GTN has a cure rate of close to 100% with chemotherapy treatment. […] Metastatic low-risk GTN has a cure rate of close to 100% with chemotherapy treatment. Metastatic high-risk GTN has a cure rate of approximately 75% with chemotherapy treatment. […] Currently, prognosis and treatment is decided using the WHO prognostic score. Patients with a WHO score of 6 or less have excellent prognosis and are initially treated with single agent chemotherapy. […] The reported cure rate for patients with low-risk disease (WHO score of 6 or less) is almost 100%. […] The survival of patients with high-risk disease (score 6) treated aggressively at specialized centers is better than 90%. […] The probability of a late recurrence after the patient has been in remission (normal serum beta-hCG titers) for 1 year is less than 1%.
  • #19 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/279116-overview
    Nonmetastatic GTN has a cure rate of close to 100% with chemotherapy treatment. […] Metastatic low-risk GTN has a cure rate of close to 100% with chemotherapy treatment. Metastatic high-risk GTN has a cure rate of approximately 75% with chemotherapy treatment. […] Currently, prognosis and treatment is decided using the WHO prognostic score. Patients with a WHO score of 6 or less have excellent prognosis and are initially treated with single agent chemotherapy. […] The reported cure rate for patients with low-risk disease (WHO score of 6 or less) is almost 100%. […] The survival of patients with high-risk disease (score 6) treated aggressively at specialized centers is better than 90%. […] The probability of a late recurrence after the patient has been in remission (normal serum beta-hCG titers) for 1 year is less than 1%.
  • #20 A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia | British Journal of Cancer
    https://www.nature.com/articles/6603608
    The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86100%). […] The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 6696%: P0.05), respectively. […] The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients. […] The 5-year overall survival was 93% (95% CI: 68100%), this dropped to 84% (95%CI: 6899%) for patient with high-risk disease. […] The outcome for patients with refractory disease is less favourable.
  • #21 A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia | British Journal of Cancer
    https://www.nature.com/articles/6603608
    The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86100%). […] The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 6696%: P0.05), respectively. […] The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients. […] The 5-year overall survival was 93% (95% CI: 68100%), this dropped to 84% (95%CI: 6899%) for patient with high-risk disease. […] The outcome for patients with refractory disease is less favourable.
  • #22 A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia | British Journal of Cancer
    https://www.nature.com/articles/6603608
    The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86100%). […] The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 6696%: P0.05), respectively. […] The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients. […] The 5-year overall survival was 93% (95% CI: 68100%), this dropped to 84% (95%CI: 6899%) for patient with high-risk disease. […] The outcome for patients with refractory disease is less favourable.
  • #23 Gestational Trophoblastic Neoplasia: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/279116-overview
    Nonmetastatic GTN has a cure rate of close to 100% with chemotherapy treatment. […] Metastatic low-risk GTN has a cure rate of close to 100% with chemotherapy treatment. Metastatic high-risk GTN has a cure rate of approximately 75% with chemotherapy treatment. […] Currently, prognosis and treatment is decided using the WHO prognostic score. Patients with a WHO score of 6 or less have excellent prognosis and are initially treated with single agent chemotherapy. […] The reported cure rate for patients with low-risk disease (WHO score of 6 or less) is almost 100%. […] The survival of patients with high-risk disease (score 6) treated aggressively at specialized centers is better than 90%. […] The probability of a late recurrence after the patient has been in remission (normal serum beta-hCG titers) for 1 year is less than 1%.
  • #24 A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia | British Journal of Cancer
    https://www.nature.com/articles/6603608
    The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86100%). […] The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 6696%: P0.05), respectively. […] The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients. […] The 5-year overall survival was 93% (95% CI: 68100%), this dropped to 84% (95%CI: 6899%) for patient with high-risk disease. […] The outcome for patients with refractory disease is less favourable.
  • #25 A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia | British Journal of Cancer
    https://www.nature.com/articles/6603608
    The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86100%). […] The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 6696%: P0.05), respectively. […] The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients. […] The 5-year overall survival was 93% (95% CI: 68100%), this dropped to 84% (95%CI: 6899%) for patient with high-risk disease. […] The outcome for patients with refractory disease is less favourable.
  • #26 Prognosis of Patients with Gestational Trophoblastic Neoplasia and Obstetric Outcomes of Those Conceiving After Chemotherapy | Anticancer Research
    https://ar.iiarjournals.org/content/36/7/3477
    Aim: To assess prognosis of gestational trophoblastic neoplasia (GTN) and obstetric outcome after chemotherapy. […] The prognosis of women with GTN is very good, and obstetric outcomes of those who conceive after chemotherapy are similar to those of the general population. […] The present investigation assessed the clinical outcome of the 20 patients with GTN. […] The patient with epithelioid trophoblastic tumor had locally advanced disease, with cervical and vaginal involvement, multiple lung metastases at presentation, and a serum hCG level of 514,967 mUI/ml. […] Currently, serum hCG is persistently less than 5 U/ml, PET/CT scan is negative, and brain CT and MRI show the disappearance of the metastatic lesion, with residual area of radionecrosis surrounded by scar tissue. […] In conclusion, the prognosis of patients with GTN is very good, with all the cases recovered by chemotherapy except for one harboring advanced epithelioid trophoblastic tumor, and the obstetric outcomes of those who conceive after chemotherapy are similar to those of the general population.
  • #27 Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11582452/
    A pivotal 2016 retrospective analysis by Bolze et al. reported a notable five-year mortality rate of 38.4% in 29 patients with scores 13 compared with a 4.9% mortality rate in high-risk patients with scores of 712. […] While the ultra-high-risk category attempts to refine prognostic accuracy by closely monitoring disease progression and forecasting outcomes, it also presents the FIGO system with the considerable challenge of precisely predicting treatment responses, recurrence rates, or mortality within a comprehensive scoring framework. […] Recent studies have revealed notable deficiencies in FIGO 2000’s ability to accurately evaluate recurrence risk. […] Despite the critical nature of these risk factors, they still do not feature in the current prognostic scoring systems, underscoring a crucial area for possible improvement.
  • #28 Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11582452/
    A pivotal 2016 retrospective analysis by Bolze et al. reported a notable five-year mortality rate of 38.4% in 29 patients with scores 13 compared with a 4.9% mortality rate in high-risk patients with scores of 712. […] While the ultra-high-risk category attempts to refine prognostic accuracy by closely monitoring disease progression and forecasting outcomes, it also presents the FIGO system with the considerable challenge of precisely predicting treatment responses, recurrence rates, or mortality within a comprehensive scoring framework. […] Recent studies have revealed notable deficiencies in FIGO 2000’s ability to accurately evaluate recurrence risk. […] Despite the critical nature of these risk factors, they still do not feature in the current prognostic scoring systems, underscoring a crucial area for possible improvement.
  • #29 Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11582452/
    A pivotal 2016 retrospective analysis by Bolze et al. reported a notable five-year mortality rate of 38.4% in 29 patients with scores 13 compared with a 4.9% mortality rate in high-risk patients with scores of 712. […] While the ultra-high-risk category attempts to refine prognostic accuracy by closely monitoring disease progression and forecasting outcomes, it also presents the FIGO system with the considerable challenge of precisely predicting treatment responses, recurrence rates, or mortality within a comprehensive scoring framework. […] Recent studies have revealed notable deficiencies in FIGO 2000’s ability to accurately evaluate recurrence risk. […] Despite the critical nature of these risk factors, they still do not feature in the current prognostic scoring systems, underscoring a crucial area for possible improvement.
  • #30 Survival for invasive mole and choriocarcinoma | Gestational trophobastic disease (GTD) | Cancer Research UK
    https://www.cancerresearchuk.org/about-cancer/gestational-trophoblastic-disease-gtd/invasive-mole-choriocarcinoma/survival
    Survival for invasive mole and choriocarcinoma is very high. Nearly all women are cured. […] Chemotherapy works very well for most women with invasive mole or choriocarcinoma. Those who need chemotherapy are divided into 3 different risk groups – low risk, high risk and ultra high risk disease. […] All women (100%) with low risk disease are successfully treated. […] All those (100%) with high risk disease are successfully treated. […] Around three quarters (75%) of those with ultra high risk disease are successfully treated.
  • #31 Gestational trophoblastic disease – Wikipedia
    https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease
    Choriocarcinoma, for example, is an uncommon, yet almost always curable cancer. Although choriocarcinoma is a highly malignant tumour and a life-threatening disease, it is very sensitive to chemotherapy. Virtually all women with non-metastatic disease are cured and retain their fertility; the prognosis is also very good for those with metastatic (spreading) cancer, in the early stages, but fertility may be lost. […] Women with a hydatidiform mole have an excellent prognosis. Women with a malignant form of GTD usually have a very good prognosis. […] The risk can be estimated by scoring systems such as the Modified WHO Prognostic Scoring System, wherein scores between 1 and 4 from various parameters are summed together. […] It is very important for malignant forms of GTD to be discovered in time. […] There have been improvements in these countries in the early detection of choriocarcinoma, thereby significantly reducing the mortality rate also in developing countries. […] Only a few women with GTD have a poor prognosis, e.g. some forms of stage IV GTN.
  • #32 Gestational trophoblastic disease – Wikipedia
    https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease
    Choriocarcinoma, for example, is an uncommon, yet almost always curable cancer. Although choriocarcinoma is a highly malignant tumour and a life-threatening disease, it is very sensitive to chemotherapy. Virtually all women with non-metastatic disease are cured and retain their fertility; the prognosis is also very good for those with metastatic (spreading) cancer, in the early stages, but fertility may be lost. […] Women with a hydatidiform mole have an excellent prognosis. Women with a malignant form of GTD usually have a very good prognosis. […] The risk can be estimated by scoring systems such as the Modified WHO Prognostic Scoring System, wherein scores between 1 and 4 from various parameters are summed together. […] It is very important for malignant forms of GTD to be discovered in time. […] There have been improvements in these countries in the early detection of choriocarcinoma, thereby significantly reducing the mortality rate also in developing countries. […] Only a few women with GTD have a poor prognosis, e.g. some forms of stage IV GTN.
  • #33 Gestational trophoblastic disease – Wikipedia
    https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease
    Choriocarcinoma, for example, is an uncommon, yet almost always curable cancer. Although choriocarcinoma is a highly malignant tumour and a life-threatening disease, it is very sensitive to chemotherapy. Virtually all women with non-metastatic disease are cured and retain their fertility; the prognosis is also very good for those with metastatic (spreading) cancer, in the early stages, but fertility may be lost. […] Women with a hydatidiform mole have an excellent prognosis. Women with a malignant form of GTD usually have a very good prognosis. […] The risk can be estimated by scoring systems such as the Modified WHO Prognostic Scoring System, wherein scores between 1 and 4 from various parameters are summed together. […] It is very important for malignant forms of GTD to be discovered in time. […] There have been improvements in these countries in the early detection of choriocarcinoma, thereby significantly reducing the mortality rate also in developing countries. […] Only a few women with GTD have a poor prognosis, e.g. some forms of stage IV GTN.
  • #34 Gestational trophoblastic disease – Wikipedia
    https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease
    Choriocarcinoma, for example, is an uncommon, yet almost always curable cancer. Although choriocarcinoma is a highly malignant tumour and a life-threatening disease, it is very sensitive to chemotherapy. Virtually all women with non-metastatic disease are cured and retain their fertility; the prognosis is also very good for those with metastatic (spreading) cancer, in the early stages, but fertility may be lost. […] Women with a hydatidiform mole have an excellent prognosis. Women with a malignant form of GTD usually have a very good prognosis. […] The risk can be estimated by scoring systems such as the Modified WHO Prognostic Scoring System, wherein scores between 1 and 4 from various parameters are summed together. […] It is very important for malignant forms of GTD to be discovered in time. […] There have been improvements in these countries in the early detection of choriocarcinoma, thereby significantly reducing the mortality rate also in developing countries. […] Only a few women with GTD have a poor prognosis, e.g. some forms of stage IV GTN.
  • #35 A comparison of patients with relapsed and chemo-refractory gestational trophoblastic neoplasia | British Journal of Cancer
    https://www.nature.com/articles/6603608
    The overall 5-year survival for patients with relapsed GTN was 93% (95% CI 86100%). […] The overall survival for patients with low-risk and high-risk disease at presentation, who subsequently relapsed was 100% (n=35), and 84% (n=25) (95% CI: 6696%: P0.05), respectively. […] The outcome of patients with relapsed GTN is good. However, patients with primary chemo-refractory disease do poorly and novel therapies are required for this group of patients. […] The 5-year overall survival was 93% (95% CI: 68100%), this dropped to 84% (95%CI: 6899%) for patient with high-risk disease. […] The outcome for patients with refractory disease is less favourable.
  • #36 Prognosticating gestational trophoblastic neoplasia: from FIGO 2000 to future models
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11582452/
    A pivotal 2016 retrospective analysis by Bolze et al. reported a notable five-year mortality rate of 38.4% in 29 patients with scores 13 compared with a 4.9% mortality rate in high-risk patients with scores of 712. […] While the ultra-high-risk category attempts to refine prognostic accuracy by closely monitoring disease progression and forecasting outcomes, it also presents the FIGO system with the considerable challenge of precisely predicting treatment responses, recurrence rates, or mortality within a comprehensive scoring framework. […] Recent studies have revealed notable deficiencies in FIGO 2000’s ability to accurately evaluate recurrence risk. […] Despite the critical nature of these risk factors, they still do not feature in the current prognostic scoring systems, underscoring a crucial area for possible improvement.
  • #37 Prognosis of Patients with Gestational Trophoblastic Neoplasia and Obstetric Outcomes of Those Conceiving After Chemotherapy | Anticancer Research
    https://ar.iiarjournals.org/content/36/7/3477
    Aim: To assess prognosis of gestational trophoblastic neoplasia (GTN) and obstetric outcome after chemotherapy. […] The prognosis of women with GTN is very good, and obstetric outcomes of those who conceive after chemotherapy are similar to those of the general population. […] The present investigation assessed the clinical outcome of the 20 patients with GTN. […] The patient with epithelioid trophoblastic tumor had locally advanced disease, with cervical and vaginal involvement, multiple lung metastases at presentation, and a serum hCG level of 514,967 mUI/ml. […] Currently, serum hCG is persistently less than 5 U/ml, PET/CT scan is negative, and brain CT and MRI show the disappearance of the metastatic lesion, with residual area of radionecrosis surrounded by scar tissue. […] In conclusion, the prognosis of patients with GTN is very good, with all the cases recovered by chemotherapy except for one harboring advanced epithelioid trophoblastic tumor, and the obstetric outcomes of those who conceive after chemotherapy are similar to those of the general population.
  • #38 Gestational trophoblastic disease – Wikipedia
    https://en.wikipedia.org/wiki/Gestational_trophoblastic_disease
    Choriocarcinoma, for example, is an uncommon, yet almost always curable cancer. Although choriocarcinoma is a highly malignant tumour and a life-threatening disease, it is very sensitive to chemotherapy. Virtually all women with non-metastatic disease are cured and retain their fertility; the prognosis is also very good for those with metastatic (spreading) cancer, in the early stages, but fertility may be lost. […] Women with a hydatidiform mole have an excellent prognosis. Women with a malignant form of GTD usually have a very good prognosis. […] The risk can be estimated by scoring systems such as the Modified WHO Prognostic Scoring System, wherein scores between 1 and 4 from various parameters are summed together. […] It is very important for malignant forms of GTD to be discovered in time. […] There have been improvements in these countries in the early detection of choriocarcinoma, thereby significantly reducing the mortality rate also in developing countries. […] Only a few women with GTD have a poor prognosis, e.g. some forms of stage IV GTN.

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beta-hCG przerzuty do płuc badania obrazowe poziom hCG przerzuty remisja śmiertelność oporność na leczenie system FIGO nawrót choroby oporność na chemioterapię nabłonkowy guz trofoblastyczny tomografia komputerowa wskaźnik przeżywalności rezonans magnetyczny mózgu płodność chemioterapia choriokarcynoma PET-CT