Treatment Outcome and Associated Factors Among Women With Gestational Trophoblastic Neoplasia in Northwest Ethiopia: A Multi-Center Retrospective Cohort Study

Abstract

Introduction Gestational trophoblastic neoplasia (GTN) is the most curable gynecologic malignancy. However, resistance to first-line chemotherapy remains common, and mortality is high in developing countries. Objective To evaluate remission, relapse, survival, and associated factors among GTN patients in northwest Ethiopia. Methods A hospital-based, multi-center retrospective cohort study was conducted on 205 patients treated between August 1, 2019, and July 31, 2024. Data were collected from medical charts and phone interviews. Logistic regression identified factors affecting remission. Kaplan–Meier analysis was used to estimate the overall survival (OS) probabilities. Prognostic factors were determined using Cox regression. Results were interpreted as adjusted odds (AOR) and adjusted hazard ratios (AHR) with 95% confidence intervals. Statistical significance was declared at P ≤ .05. Results The overall remission rate was 62.4%, with 41.0% of low-risk GTN patients developing resistance to monotherapy. Chemo-resistance was independently associated with FIGO/WHO scores of 5-6 (AOR = 2.4, 95% CI: 1.2-5.6), disease duration ≥4 months (AOR = 1.7, 95% CI: 1.0-3.3), metastases (AOR = 2.2, 95% CI: 1.1-4.6), and choriocarcinoma histology (AOR = 3.0, 95% CI: 1.3-6.7). The 5-year OS was 77%, with metastases independently predicting poor survival (AHR = 4.1, 95% CI: 1.0-15.9). Choriocarcinoma and high-risk GTN were associated with increased relapse. Conclusion Chemoresistance was notably high among low-risk GTN patients. Particularly, patients with metastasis, choriocarcinoma histology, a WHO-FIGO risk score of 5-6, and longer disease duration may benefit from early combination therapy. In addition, GTN patients have shown relatively low survival rates. Metastases significantly affect survival. These findings highlight the importance of early detection, risk-adapted therapy, and therapeutic advancements to improve outcomes in resource-limited settings.