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Abstract：
BACKGROUND: Gestational trophoblastic neoplasia (GTN) is a highly invasive tumor, mainly spreading to the lungs. However, lung metastasis in GTN is usually not considered as an adverse prognostic factor. Therefore, the aim of this study was to summarize the results of previous studies and evaluate the effects of lung metastasis on the treatment and prognosis of GTN.
METHODS: The study was prospectively registered in PROSPERO (CRD42023372371). Electronic databases including PubMed, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, and China Biomedical Literature Database were used for a systematical search of relevant studies published up to November 21, 2022. The observational studies reporting the clinical outcomes of GTN patients with and without lung metastasis were selected. The incidences of resistance, relapse, and mortality of GTN patients were extracted and successively grouped based on the presence of lung metastasis. The pooled relative risks (RRs) and 95% confidence interval (95% CI) of the eligible studies were calculated. The qualities of included studies were assessed with the Newcastle-Ottawa Scale and the certainty of evidence was graded based on the GRADE. The meta-analysis was performed using Stata 12.0 and GradePro software.
RESULTS: Five publications with 3629 GTN patients were included. The meta-analysis revealed that the GTN with lung metastasis was strongly correlated with first-line chemoresistance (pooled RR = 1.40, 95% CI: 1.22 to 1.61, p < 0.001), recurrence (pooled RR = 3.03, 95% CI: 1.21 to 7.62, p = 0.018), and disease-specific death (pooled RR = 22.11, 95% CI: 3.37 to 145.08, p = 0.001). Ethnicity was also an important factor and Caucasian GTN patients with lung metastasis showed a higher risk of recurrence as revealed by the subgroup analysis (pooled RR = 5.10, 95% CI: 2.38 to 10.94, p < 0.001).
CONCLUSIONS: GTN patients with lung metastasis exhibited a higher risk of chemoresistance, relapse, and disease-specific death. Patients with lung metastasis among the Caucasian population had a higher risk of recurrence than Asian populations. Therefore, the presence of lung metastases might be considered as a high-risk factor for prognosis of GTN and deserves more attention in the choice of first-line chemotherapy regimens and follow-up.
METHODS: The study was prospectively registered in PROSPERO (CRD42023372371). Electronic databases including PubMed, Embase, the Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, and China Biomedical Literature Database were used for a systematical search of relevant studies published up to November 21, 2022. The observational studies reporting the clinical outcomes of GTN patients with and without lung metastasis were selected. The incidences of resistance, relapse, and mortality of GTN patients were extracted and successively grouped based on the presence of lung metastasis. The pooled relative risks (RRs) and 95% confidence interval (95% CI) of the eligible studies were calculated. The qualities of included studies were assessed with the Newcastle-Ottawa Scale and the certainty of evidence was graded based on the GRADE. The meta-analysis was performed using Stata 12.0 and GradePro software.
RESULTS: Five publications with 3629 GTN patients were included. The meta-analysis revealed that the GTN with lung metastasis was strongly correlated with first-line chemoresistance (pooled RR = 1.40, 95% CI: 1.22 to 1.61, p < 0.001), recurrence (pooled RR = 3.03, 95% CI: 1.21 to 7.62, p = 0.018), and disease-specific death (pooled RR = 22.11, 95% CI: 3.37 to 145.08, p = 0.001). Ethnicity was also an important factor and Caucasian GTN patients with lung metastasis showed a higher risk of recurrence as revealed by the subgroup analysis (pooled RR = 5.10, 95% CI: 2.38 to 10.94, p < 0.001).
CONCLUSIONS: GTN patients with lung metastasis exhibited a higher risk of chemoresistance, relapse, and disease-specific death. Patients with lung metastasis among the Caucasian population had a higher risk of recurrence than Asian populations. Therefore, the presence of lung metastases might be considered as a high-risk factor for prognosis of GTN and deserves more attention in the choice of first-line chemotherapy regimens and follow-up.
摘要：
背景：妊娠滋养细胞瘤（GTN）是一种高侵袭性肿瘤，主要扩散到肺部。然而,GTN的肺转移通常不被认为是不良预后因素.因此,本研究的目的是总结以往的研究结果，评估肺转移对GTN治疗和预后的影响。
方法：该研究在PROSPERO（CRD42023372371）中进行了前瞻性登记。电子数据库，包括PubMed，Embase,Cochrane图书馆,中国国家知识基础设施，万方,和中国生物医学文献数据库用于对截至2022年11月21日发表的相关研究进行系统搜索。选择报告有和没有肺转移的GTN患者临床结局的观察性研究。抵抗的发生率，复发,提取GTN患者的死亡率，并根据是否存在肺转移依次分组。计算合格研究的合并相对风险（RR）和95％置信区间（95％CI）。采用纽卡斯尔-渥太华量表评估纳入研究的质量，并根据GRADE对证据的确定性进行分级。Meta分析采用Stata12.0和GradePro软件进行。
结果：纳入了5篇出版物，共3629例GTN患者。荟萃分析显示，GTN伴肺转移与一线化疗耐药密切相关（合并RR=1.40，95％CI：1.22至1.61，p<0.001），复发（合并RR=3.03，95%CI：1.21至7.62，p=0.018），和疾病特异性死亡（合并RR=22.11，95％CI：3.37至145.08，p=0.001）。种族也是一个重要因素，亚组分析显示，有肺转移的高加索GTN患者复发风险较高（合并RR=5.10，95％CI：2.38至10.94，p<0.001）。
结论：GTN肺转移患者出现化疗耐药的风险更高，复发,和疾病特异性死亡。与亚洲人群相比，高加索人群中有肺转移的患者复发风险更高。因此,肺转移的存在可能被认为是GTN预后的高危因素,在一线化疗方案的选择和随访中值得更多关注.
方法：该研究在PROSPERO（CRD42023372371）中进行了前瞻性登记。电子数据库，包括PubMed，Embase,Cochrane图书馆,中国国家知识基础设施，万方,和中国生物医学文献数据库用于对截至2022年11月21日发表的相关研究进行系统搜索。选择报告有和没有肺转移的GTN患者临床结局的观察性研究。抵抗的发生率，复发,提取GTN患者的死亡率，并根据是否存在肺转移依次分组。计算合格研究的合并相对风险（RR）和95％置信区间（95％CI）。采用纽卡斯尔-渥太华量表评估纳入研究的质量，并根据GRADE对证据的确定性进行分级。Meta分析采用Stata12.0和GradePro软件进行。
结果：纳入了5篇出版物，共3629例GTN患者。荟萃分析显示，GTN伴肺转移与一线化疗耐药密切相关（合并RR=1.40，95％CI：1.22至1.61，p<0.001），复发（合并RR=3.03，95%CI：1.21至7.62，p=0.018），和疾病特异性死亡（合并RR=22.11，95％CI：3.37至145.08，p=0.001）。种族也是一个重要因素，亚组分析显示，有肺转移的高加索GTN患者复发风险较高（合并RR=5.10，95％CI：2.38至10.94，p<0.001）。
结论：GTN肺转移患者出现化疗耐药的风险更高，复发,和疾病特异性死亡。与亚洲人群相比，高加索人群中有肺转移的患者复发风险更高。因此,肺转移的存在可能被认为是GTN预后的高危因素,在一线化疗方案的选择和随访中值得更多关注.
