A Review of Clinico-pathological Characteristics, Treatment and Survival, Among High-risk Gtn Patients Managed in Kenyatta National Hospital Between 2013-2019

Abstract

BACKGROUND High risk Gestational Trophoblastic Neoplasia (GTN) is a common cause of morbidity and mortality all over the world. It contributes 2% of all reproductive tract malignancies in Kenya. The problem is grave in resource – poor third world countries where specialized GTN treatment centers do not exist, and poor referral systems is the norm compounded with lack of well-trained health workers to handle suspected cases. It is therefore useful to gather epidemiological data to guide in the routine diagnosis, treatment and follow-up of this malignancy BROAD OBJECTIVES A review of Clinico-pathological characteristics, treatment options, treatment outcomes among high-risk GTN patients managed in Kenyatta National Hospital, Kenya between 2013 – 2019. METHODOLOGY Study design A descriptive retrospective cross-sectional study 2013-2019 Study site and setting Oncology Unit, department of Obstetrics and Gynecology KNH, Nairobi, Kenya Study population Patients managed for High-risk GTN 2013-2019 Inclusion criteria Patients managed for High-risk GTN at KNH between 2013 and 2019 Exclusion criteria Missing files and files with incomplete data. Sample size Total calculated sample size was 73 Data collection Descriptive variables, variables in management of High risk GTN, date and time of death were collected. Data was captured electronically into the REDcap software. Data analysis Data with descriptive statistics were summarized. Age was presented as means (SD), while categorical data was presented in proportions. Kaplan Meier curves were used to determine 2 and 5 year survivals for High-risk GTN patients. Patients who were still alive or lost to follow-up were censured in the survival analysis. RESULTS A total of 64 files were analyzed. The mean age of patients reviewed was 35 years. 92.2% had never done a pap smear before. Only 4.7% were H.I.V. Positive. The most frequently used imaging modality was pelvic ultrasound. Chemotherapy alone was the main mode of treatment. The 2-year survival was 18% while 5-year survival was 10%. Conclusion Most patients presented with per-vaginal bleeding. 50% of the patients died of haemorrhage. Chemotherapy is the main mode of treatment of High-Risk GTN in Kenyatta National Hospital.