Comprehensive Five-Year Review of Gestational Trophoblastic Disease and Gestational Trophoblastic Neoplasm: Prevalence, Risk Factors and Outcomes at Hospital Sultan Ismail, Johor Bahru
Jia Ling Tai *
Department of Obstetrics and Gynaecology, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Johor 81100, Malaysia.
Maizatulernawani Binti Hashim
Department of Obstetrics and Gynaecology, Hospital Sultan Ismail, Ministry of Health Malaysia, Johor Bahru, Johor 81100, Malaysia.
*Author to whom correspondence should be addressed.
Abstract
Aim: Gestational trophoblastic disease (GTD) encompasses a spectrum of pregnancy-related trophoblastic disorders, ranging from premalignant hydatidiform moles to malignant gestational trophoblastic neoplasia (GTN). This study aimed to evaluate the demographic and clinical characteristics, risk factors for GTN, treatment modalities and outcomes of GTN.
Study Design: A five-year retrospective observational study.
Methodology: The study was conducted at Hospital Sultan Ismail, Johor Bahru, and involved patients diagnosed with GTD between 1 January 2021 and 31 December 2025. Demographic characteristics, clinical presentation, histopathological diagnosis, β-hCG levels, responses to different treatment modalities and outcomes were assessed.
Results: A total of 114 cases of GTD were identified, corresponding to an incidence of 2.08 per 1,000 deliveries. The mean age was 31.84 years, and 77.1% of patients were multiparous. Postmolar GTN developed in 42 patients (40.8%). Complete mole was associated with a higher risk of postmolar GTN compared with partial mole (50.0% versus 27.9%; RR = 1.79; P = 0.024). Patients with GTN had a significantly larger uterine size (p < 0.001). Elevated serum β-hCG (100,000–<500,000 IU/L) was independently associated with GTN (p = 0.028). Among 53 patients with GTN, 43 (81.1%) were low-risk and 10 (18.9%) were high-risk. Remission was achieved in 97.7% of low-risk and 70.0% of high-risk patients. High FIGO risk was associated with increased odds of requiring salvage chemotherapy or surgical intervention (OR = 7.03, 95% CI: 1.67–29.55; P = 0.008).
Conclusion: This five-year review provides an overview of the clinical characteristics, management patterns and treatment outcomes of GTD. Although remission was achieved in most patients with high-risk GTN, chemotherapy resistance and disease-related mortality remained important challenges. Early identification of patients at risk of disease progression, appropriate risk stratification, timely treatment and structured follow-up are essential to optimise clinical outcomes.
Keywords: Gestational trophoblastic disease, hydatidiform mole, gestational trophoblastic neoplasia, methotrexate