{"doi":"10.1111/1471-0528.17374","title":"Treatments and outcomes in high‐risk gestational trophoblastic neoplasia: A systematic review and meta‐analysis","abstract":"BACKGROUND: High-risk gestational trophoblastic neoplasia (GTN) is rare and treated with diverse approaches. Limited published institutional data has yet to be systematically reviewed. OBJECTIVES: To compile global high-risk GTN (prognostic score ≥7) cohorts to summarise treatments and outcomes by disease characteristics and primary chemotherapy. SEARCH STRATEGY: MEDLINE, Embase, Scopus, ClinicalTrials.gov and Cochrane were searched through March 2021. SELECTION CRITERIA: Full-text manuscripts reporting mortality among ≥10 high-risk GTN patients. DATA COLLECTION AND ANALYSIS: Binomial proportions were summed, and random-effects meta-analyses performed. MAIN RESULTS: From 1137 records, we included 35 studies, representing 20 countries. Among 2276 unique high-risk GTN patients, 99.7% received chemotherapy, 35.8% surgery and 4.9% radiation. Mortality was 10.9% (243/2236; meta-analysis: 10%, 95% confidence interval [CI] 7-12%) and likelihood of complete response to primary chemotherapy was 79.7% (1506/1890; meta-analysis: 78%, 95% CI: 74-83%). Across 24 reporting studies, modern preferred chemotherapy (EMA/CO or EMA/EP) was associated with lower mortality (overall: 8.8 versus 9.5%; comparative meta-analysis: 8.1 versus 12.4%, OR 0.42, 95% CI: 0.20-0.90%, 14 studies) and higher likelihood of complete response (overall: 76.6 versus 72.8%; comparative meta-analysis: 75.9 versus 60.7%, OR 2.98, 95% CI: 1.06-8.35%, 14 studies), though studies focused on non-preferred regimens reported comparable outcomes. Mortality was increased for ultra-high-risk disease (30 versus 7.5% high-risk; meta-analysis OR 7.44, 95% CI: 4.29-12.9%) and disease following term delivery (20.8 versus 7.3% following molar pregnancy; meta-analysis OR 2.64, 95% CI: 1.10-6.31%). Relapse rate estimates ranged from 3 to 6%. CONCLUSIONS: High-risk GTN is responsive to several chemotherapy regimens, with EMA/CO or EMA/EP associated with improved outcomes. Mortality is increased in patients with ultra-high-risk, relapsed and post-term pregnancy disease.","journal":"BJOG An International Journal of Obstetrics & Gynaecology","year":2023,"id":335857,"datarank":0.9615707278876118,"base_score":2.995732273553991,"endowment":2.995732273553991,"self_citation_contribution":0.4493598410330987,"citation_network_contribution":0.5122108868545131,"self_endowment_contribution":0.4493598410330987,"citer_contribution":0.5122108868545131,"corpus_percentile":78.97423996286841,"corpus_rank":2719,"citation_count":19,"citer_count":19,"citers_with_citation_signal":14,"citers_with_endowment":14,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.6457,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1065846,"name":"Tressa Ellett","orcid":"0000-0003-1034-6892","position":1,"is_corresponding":false},{"id":904263,"name":"Hope Knochenhauer","orcid":"0000-0001-5137-6428","position":2,"is_corresponding":false},{"id":1066314,"name":"Emily C. Goins","orcid":null,"position":3,"is_corresponding":false},{"id":663490,"name":"Karen Monuszko","orcid":"0000-0001-9142-0497","position":4,"is_corresponding":false},{"id":286399,"name":"Samantha Kaplan","orcid":"0000-0001-5340-1754","position":5,"is_corresponding":false},{"id":545979,"name":"Rebecca A. Previs","orcid":"0000-0001-8087-9120","position":6,"is_corresponding":false},{"id":286398,"name":"Haley Moss","orcid":"0000-0002-0563-1579","position":7,"is_corresponding":false},{"id":402050,"name":"Laura J. Havrilesky","orcid":"0000-0002-4259-5992","position":8,"is_corresponding":false},{"id":484615,"name":"Brittany A. Davidson","orcid":"0000-0001-9698-0442","position":9,"is_corresponding":false},{"id":458427,"name":"Benjamin B. Albright","orcid":"0000-0001-5296-9575","position":0,"is_corresponding":true}],"reference_count":71,"raw_metadata":null,"created_at":"2026-07-19T01:10:02.777338Z","pmid":"36648416","pmcid":"PMC10066712","fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}