Outcomes and Predictors of Treatment Failure Among Patients Managed for Low-risk Gestational Trophoblastic Neoplasia on First-line Single-agent Chemotherapy at Kenyatta National Hospital From 2013 to 2022

Abstract

Background Low-risk gestational trophoblastic neoplasia (GTN) responds well to single-agent first-line chemotherapy with remission rates of 50% to 100%. There is consensus to treat low-risk GTN with a World Health Organization (WHO) score of 0–4 with sequential single-agent chemotherapy with methotrexate or Actinomycin D. Patients with WHO score 0-4 with pretreatment human chorionic gonadotrophin levels >400,000mIU/L, histology of choriocarcinoma or metastasis, and patients with a WHO score of 5-6 achieve lower remission rates on single agent first-line chemotherapy and their optimal first-line treatment is not well established. There is a need to further evaluate the outcomes and predictors of single-agent first-line treatment failure for better treatment triaging of low-risk GTN patients. There is scant local data on the outcomes and predictors of treatment failure for low-risk GTN managed on single agent first-line. Broad objective: To determine the outcomes of single-agent first-line chemotherapy and factors predictive of single-agent first-line treatment failure among patients managed for lowrisk gestational neoplasia at Kenyatta National Hospital (KNH), 2013-2022. Study Population: Files of forty-one patients with low-risk GTN managed on first-line singleagent chemotherapy at KNH from 1st January 2013 to 31st December 2022. Study Site: This study was conducted at the KNH records department. Study design This was a retrospective descriptive cohort study. Data management and analysis Data was transferred from the abstraction tool to an Excel sheet and then exported to Stata version 17 for analysis. Continuous data was presented as mean, standard deviation, and range values. Categorical variables were presented as proportions. Skewed data was summarized as median and interquartile range values. Predictors of single agent failure were tested by univariate tests; χ² test for association of categorical variables; and Student’s t-test for continuous variables. The Odd’s Ratio and the corresponding 95% confidence interval were obtained. Statistical significance was assumed if the P-value was < 0.05. Results...