Gestational trophoblastic neoplasia in the Western Brazilian Amazon: Patient characteristics and impact of referral center restructuring
- 1Tocogynecology – CAPES-Dinter, São Paulo State University (UNESP), Medical School, Av. Professor Mário Rubens Guimarães Montenegro, s/n°, Botucatu, SP, 18618-687, Brazil
- 2Amazonas Oncology Control Center (FCECON)- Rua Francisco Orellana, 215, Planalto Cep: 69040-010, Manaus, AM, Brazil
- 3New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
Abstract
Objective
To describe the demographic and clinical characteristics of patients with gestational trophoblastic neoplasia (GTN) managed at the Gestational Trophoblastic Disease Referral Center of Amazonas (RC-GTD Amazonas) and to assess the impact of the center's restructuring on treatment outcomes.Methods
This ambispective cohort study included women treated for GTN at RC-GTD Amazonas, AM, Brazil, between 2011 and 2022. Patients were grouped according to treatment period: before (2011-2019) and after (2020-2022) the center's restructuring. Demographic, clinical, and treatment data were collected from medical records. Outcomes included treatment characteristics, loss to follow-up, chemotherapy regimen changes, and mortality.Results
A total of 29 patients were treated, 11 before and 18 after restructuring. Most patients were young, of low socioeconomic status, and self-identified as parda or Indigenous. Post-molar GTN accounted for 76% of cases. After restructuring, there was a marked reduction in chemotherapy regimen changes and a significant decrease in loss to post-molar follow-up. Pre-treatment hCG levels were higher post-restructuring, likely reflecting more systematic and timely assessment. Overall mortality was 17%, with no significant difference between periods. All fatal cases were high-risk GTN and associated with advanced disease, treatment delay, and metastatic involvement. Hemorrhagic shock due to vaginal metastases was the leading cause of death.Conclusion
The restructuring of RC-GTD Amazonas improved treatment standardization and patient follow-up, even during the COVID-19 pandemic. Although mortality was unchanged, the findings highlight the importance of organized referral pathways, early diagnosis, and institutional preparedness to manage acute complications in geographically complex and resource-limited settings.
Related
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- Epidemiology, treatment patterns, and outcomes in gestational trophoblastic neoplasia: a systematic review
- Chemotherapy resistance and risk stratification in gestational trophoblastic neoplasia: A systematic review and network meta‐analysis
- Gestational Trophoblastic Disease and Its Outcome at Shri Maharaja Gulab Singh Hospital, Jammu, India: A Retrospective Data Analysis
- Laparoscopic and Robot-Assisted Surgery for Gestational Trophoblastic Disease: A Scoping Review of Patient Selection and Intraoperative Precautions.
BibTeX
@article{paolino2026gestational,
title = {{Gestational trophoblastic neoplasia in the Western Brazilian Amazon: Patient characteristics and impact of referral center restructuring}},
author = {Bruno Monção Paolino and Izildinha Maesta and Michelle Navarro Ferreira Paolino and Lia Mizobe Ono and Ross S. Berkowitz and Neil S. Horowitz},
journal = {Gynecologic oncology reports},
year = {2026},
month = oct,
doi = {10.1016/j.gore.2026.102234},
url = {https://europepmc.org/article/PMC/PMC13716955},
note = {CC BY},
}
RIS
TY - JOUR
TI - Gestational trophoblastic neoplasia in the Western Brazilian Amazon: Patient characteristics and impact of referral center restructuring
AU - Bruno Monção Paolino
AU - Izildinha Maesta
AU - Michelle Navarro Ferreira Paolino
AU - Lia Mizobe Ono
AU - Ross S. Berkowitz
AU - Neil S. Horowitz
PY - 2026
DA - 2026/10/01
JO - Gynecologic oncology reports
DO - 10.1016/j.gore.2026.102234
UR - https://europepmc.org/article/PMC/PMC13716955
AB - Objective To describe the demographic and clinical characteristics of patients with gestational trophoblastic neoplasia (GTN) managed at the Gestational Trophoblastic Disease Referral Center of Amazonas (RC-GTD Amazonas) and to assess the impact of the center's restructuring on treatment outcomes.Methods This ambispective cohort study included women treated for GTN at RC-GTD Amazonas, AM, Brazil, between 2011 and 2022. Patients were grouped according to treatment period: before (2011-2019) and after (2020-2022) the center's restructuring. Demographic, clinical, and treatment data were collected from medical records. Outcomes included treatment characteristics, loss to follow-up, chemotherapy regimen changes, and mortality.Results A total of 29 patients were treated, 11 before and 18 after restructuring. Most patients were young, of low socioeconomic status, and self-identified as parda or Indigenous. Post-molar GTN accounted for 76% of cases. After restructuring, there was a marked reduction in chemotherapy regimen changes and a significant decrease in loss to post-molar follow-up. Pre-treatment hCG levels were higher post-restructuring, likely reflecting more systematic and timely assessment. Overall mortality was 17%, with no significant difference between periods. All fatal cases were high-risk GTN and associated with advanced disease, treatment delay, and metastatic involvement. Hemorrhagic shock due to vaginal metastases was the leading cause of death.Conclusion The restructuring of RC-GTD Amazonas improved treatment standardization and patient follow-up, even during the COVID-19 pandemic. Although mortality was unchanged, the findings highlight the importance of organized referral pathways, early diagnosis, and institutional preparedness to manage acute complications in geographically complex and resource-limited settings.
SN - 2352-5789
ER -