Abstract：
International societies advocate for gestational trophoblastic neoplasia referral to designated expert centers. This study assessed the impact of centralization of trophoblastic care on clinical outcomes.
A centralized program was implemented in 2018 at two affiliated academic hospitals, Princess Margaret Cancer Center and Mount Sinai Hospital. A retrospective analysis of patients treated between 2000 and 2022 was performed and the clinical outcomes were compared before (2000-2017) and after (2018-2022) centralization. Statistical analyses were performed with significance set as p<0.05.
A total of 94 patients with trophoblastic neoplasia were included: 60 pre-centralization and 34 post-centralization, 79.8% low-risk and 18.1% high-risk. Centralization led to significant improvement for: (1) accurate score documentation (from 37.9% to 89.3%,); (2) contraception counseling (from 67.2% to 96.7%); (3) median time from diagnosis to chemotherapy (from 9 days to 1 day); and (4) incomplete follow-up (from 20.7% to 3.3%) (all p<0.05). First-line chemotherapy for low-risk neoplasia was dactinomycin in 47.9% and 87.0% pre- and post-centralization, respectively (p=0.005). The median number of chemotherapy cycles decreased from seven to four (p=0.01), and the median number of consolidation cycles increased from two to three (p<0.001). Serum human chorionic gonadotropin (hCG) levels of 10 000-100 000 IU/L were significantly associated with longer time to hCG normalization and higher risk of resistance to first-line chemotherapy compared with hCG levels <1000 IU/L.
Centralization of trophoblastic neoplasia care leads to greater guideline compliance, faster chemotherapy initiation, fewer chemotherapy cycles with optimized consolidation, and enhanced surveillance completion. This supports the establishment of trophoblastic neoplasia expert centers.
A centralized program was implemented in 2018 at two affiliated academic hospitals, Princess Margaret Cancer Center and Mount Sinai Hospital. A retrospective analysis of patients treated between 2000 and 2022 was performed and the clinical outcomes were compared before (2000-2017) and after (2018-2022) centralization. Statistical analyses were performed with significance set as p<0.05.
A total of 94 patients with trophoblastic neoplasia were included: 60 pre-centralization and 34 post-centralization, 79.8% low-risk and 18.1% high-risk. Centralization led to significant improvement for: (1) accurate score documentation (from 37.9% to 89.3%,); (2) contraception counseling (from 67.2% to 96.7%); (3) median time from diagnosis to chemotherapy (from 9 days to 1 day); and (4) incomplete follow-up (from 20.7% to 3.3%) (all p<0.05). First-line chemotherapy for low-risk neoplasia was dactinomycin in 47.9% and 87.0% pre- and post-centralization, respectively (p=0.005). The median number of chemotherapy cycles decreased from seven to four (p=0.01), and the median number of consolidation cycles increased from two to three (p<0.001). Serum human chorionic gonadotropin (hCG) levels of 10 000-100 000 IU/L were significantly associated with longer time to hCG normalization and higher risk of resistance to first-line chemotherapy compared with hCG levels <1000 IU/L.
Centralization of trophoblastic neoplasia care leads to greater guideline compliance, faster chemotherapy initiation, fewer chemotherapy cycles with optimized consolidation, and enhanced surveillance completion. This supports the establishment of trophoblastic neoplasia expert centers.
摘要：
目的：国际社会提倡将妊娠滋养细胞肿瘤转诊到指定的专家中心。这项研究评估了滋养细胞护理集中对临床结局的影响。
方法：2018年在两家附属学术医院实施了集中计划，玛格丽特公主癌症中心和西奈山医院。对2000年至2022年之间接受治疗的患者进行回顾性分析，并比较了集中治疗之前（2000-2017年）和之后（2018-2022年）的临床结果。进行统计学分析,显著性设定为p<0.05。
结果：共纳入94例滋养细胞肿瘤患者：60例集中前和34例集中后。低风险79.8%，高风险18.1%。集中化带来了以下方面的重大改进：(1)准确的分数文件(从37.9%到89.3%，）；（2）避孕咨询（从67.2％到96.7％）；（3）从诊断到化疗的中位时间（从9天到1天）；（4）不完全随访（从20.7％到3.3％）（所有p<0.05）。低危肿瘤的一线化疗是放线菌素在集中前后占47.9％和87.0％，分别(p=0.005)。化疗周期的中位数从7个减少到4个（p=0.01），巩固周期的中位数从2个增加到3个（p<0.001）。与hCG水平<1000IU/L相比，血清人绒毛膜促性腺激素（hCG）水平为10000-100000IU/L与hCG正常化时间更长和对一线化疗耐药风险更高显著相关。
结论：集中化滋养细胞瘤形成治疗可提高指南依从性，更快的化疗开始，更少的化疗周期与优化巩固，并加强监控完成。这支持了滋养细胞瘤形成专家中心的建立。
方法：2018年在两家附属学术医院实施了集中计划，玛格丽特公主癌症中心和西奈山医院。对2000年至2022年之间接受治疗的患者进行回顾性分析，并比较了集中治疗之前（2000-2017年）和之后（2018-2022年）的临床结果。进行统计学分析,显著性设定为p<0.05。
结果：共纳入94例滋养细胞肿瘤患者：60例集中前和34例集中后。低风险79.8%，高风险18.1%。集中化带来了以下方面的重大改进：(1)准确的分数文件(从37.9%到89.3%，）；（2）避孕咨询（从67.2％到96.7％）；（3）从诊断到化疗的中位时间（从9天到1天）；（4）不完全随访（从20.7％到3.3％）（所有p<0.05）。低危肿瘤的一线化疗是放线菌素在集中前后占47.9％和87.0％，分别(p=0.005)。化疗周期的中位数从7个减少到4个（p=0.01），巩固周期的中位数从2个增加到3个（p<0.001）。与hCG水平<1000IU/L相比，血清人绒毛膜促性腺激素（hCG）水平为10000-100000IU/L与hCG正常化时间更长和对一线化疗耐药风险更高显著相关。
结论：集中化滋养细胞瘤形成治疗可提高指南依从性，更快的化疗开始，更少的化疗周期与优化巩固，并加强监控完成。这支持了滋养细胞瘤形成专家中心的建立。
