1211 Mortality and clinicopathological characteristics associated with gestational trophoblastic neoplasia in a low-resource setting: a 10-year experience in western Kenya

Abstract

<h3>Introduction/Background</h3> Gestational Trophoblastic Neoplasia (GTN) was fatal before the development of effective chemotherapy. Prognosis is known to be dependent on early diagnosis, appropriate, timely, and adequate management. In low-middle-income countries (LMIC), patients often present late and may get suboptimal treatment due to challenges with inadequate staffing and lack of resources. <h3>Methodology</h3> Retrospective study involving review of the prospectively kept GTN database with supplemental information from medical charts of GTN patients managed at the Moi Teaching and Referral Hospital (MTRH) over 10 years (2013–2022) which resulted in mortality. Descriptive statistics were generated for socio-demographic, diagnostic, disease, and therapeutic and associated complications. Frequencies and percentages were used to describe the patient characteristics, treatment, and associated complications. IBM SPSS Statistics for Windows was used for analysis. <h3>Results</h3> Out of the 31 cases analyzed, the median age was 28 years, more than 80% of the women were referrals while 68% had no health insurance. All the women who died of GTN had metastatic disease with 100% having metastasis to either the liver, brain, lung, or gastrointestinal. Ultra-high-risk was noted in 52% of the women and 45% had stage 4 disease. Of the 90% who received chemotherapy, 71% experienced delay in treatment while 19% developed resistance and went on to have sequential treatment with other regimens. The majority (81%) developed bone marrow suppression with 32% having neutropenic sepsis. All the women died before or during treatment and the majority of the mortalities (58%) were early deaths (death occurring in the first four weeks of treatment initiation). <h3>Conclusion</h3> The majority of mortalities from GTN are of patients with ultra-high-risk disease with a heavy disease burden and multiorgan metastasis. While the majority received chemotherapy more than 75% of the women did not receive upfront appropriate treatment or timely referral, and there were delays in commencing treatment for most of the women. <h3>Disclosures</h3> None