NATURAL-HISTORY OF POSTTERM CHORIOCARCINOMA

OBJECTIVE: To review the 32-year experience of the New England Trophob lastic Disease Center (NETDC) with choriocarcinoma occurring after a t erm gestation and to evaluate potential prognostic factors using the W ould Health Organization (WHO) prognostic score. STUDY DESIGN: The cha rts of 44 women who were treated for postterm choriocarcinoma at the N ETDC from August 1964 to January 1996 were retrospectively reviewed. D emographic data and details of the clinical course were determined. Po tential risk factors, including disease duration, pretreatment human c horionic gonadotropin (hCG) level, sites of metastases and stage, as w ell as data regarding the infants and previous and subsequent pregnanc ies, were evaluated. RESULTS: Five (11%) of the infants suffered signi ficant complications secondary to maternal choriocarcinoma. The time i nterval from delivery to diagnosis, pretreatment hCG level and sites o f metastatic disease were all significant risk factors in predicting o utcome. All 31 patients with a WHO score less than or equal to 8 survi ved, and 6/13 (46%) patients with a WHO score >8 died. CONCLUSION: Dis ease duration greater than four months from delivery, pretreatment hCG level >100,000 mIU/mL, presence of liver or brain metastases, and a W HO score > 8 were all important predictors of outcome in patients with postterm choriocarcinoma.