The impact of the distance traveled between residence and gestational trophoblastic neoplasia reference center and clinical outcomes in Brazilian women

Antonio Braga; Renata Lopes; Vanessa Campos; Fernanda Freitas; Izildinha Maestá; Sue Yazaki Sun; Luana Giongo Pedrotti; Marina Bessel; Christiani Bisinoto de Sousa; Elaine Leal; Daniela Yela; Elza Uberti; José Mauro Madi; Mauricio Viggiano; Joffre Amim Junior; Jorge Rezende Filho; Kevin M Elias; Neil S Horowitz; Ross S Berkowitz

doi:10.1016/j.ygyno.2023.07.012

The impact of the distance traveled between residence and gestational trophoblastic neoplasia reference center and clinical outcomes in Brazilian women

Gynecol Oncol. 2023 Sep:176:130-138. doi: 10.1016/j.ygyno.2023.07.012. Epub 2023 Jul 29.

Authors

Antonio Braga¹, Renata Lopes², Vanessa Campos³, Fernanda Freitas³, Izildinha Maestá⁴, Sue Yazaki Sun⁵, Luana Giongo Pedrotti⁶, Marina Bessel⁶, Christiani Bisinoto de Sousa⁷, Elaine Leal⁸, Daniela Yela⁹, Elza Uberti¹⁰, José Mauro Madi¹¹, Mauricio Viggiano¹², Joffre Amim Junior², Jorge Rezende Filho², Kevin M Elias¹³, Neil S Horowitz¹³, Ross S Berkowitz¹³

Affiliations

¹ Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University), Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil; Postgraduate Program in Applied Health Sciences, Vassouras University, Rio de Janeiro, RJ, Brazil; National Academy of Medicine, Young Leadership Physicians Program, Rio de Janeiro, RJ, Brazil. Electronic address: antonio.braga@ufrj.br.
² Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University), Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.
³ Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University), Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil.
⁴ Botucatu Trophoblastic Disease Center of the Clinical Hospital of Botucatu Medical School, Department of Gynecology and Obstetrics, São Paulo State University - UNESP, Botucatu, SP, Brazil.
⁵ Departament of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
⁶ Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.
⁷ Universidade de São Paulo, Hospital das Clínicas of the Ribeirão Preto School of Medicine, Department of Gynecology and Obstetrics, Ribeirão Preto, SP, Brazil.
⁸ Rio Branco Trophoblastic Disease Center, Clinics Hospital of Acre, Rio Branco, AC, Brazil.
⁹ Campinas Trophoblastic Disease Center, University of Campinas, Campinas, SP, Brazil.
¹⁰ Porto Alegre Trophoblastic Disease Center, Mario Totta Maternity Ward, Irmandade da Santa Casa de Misericórdia Hospital, Porto Alegre, RS, Brazil.
¹¹ Caxias do Sul Trophoblastic Disease Center, General Hospital of Caxias do Sul, School of Medicine, Center for Biological and Health Sciences, Caxias do Sul University, Caxias do Sul, RS, Brazil.
¹² Goiania Trophoblastic Disease Center (Clinics Hospital of Goias Federal University), Goiania, GO, Brazil.
¹³ New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.

PMID: 37524011
DOI: 10.1016/j.ygyno.2023.07.012

Abstract

Objective: To relate the distance traveled from the patient's residence to the gestational trophoblastic neoplasia (GTN) reference center (RC) and the occurrence of unfavorable clinical outcomes, as well as to estimate the possible association between this distance and the risk of metastatic disease at presentation, the need for multiagent chemotherapy to achieve remission and loss to follow-up before remission.

Study design: Retrospective historical cohort study of patients with GTN followed at 8 Brazilian GTN-RC, from January 1st, 2000 - December 31st, 2017.

Results: Evaluating 1055 cases of GTN, and using a receiver operating characteristic curve, we found a distance of 56 km (km) from the residence to the GTN-RC (sensitivity = 0.57, specificity = 0.61) best predicted the occurrence of at least one of the following outcomes: occurrence of metastatic disease, need for multiagent chemotherapy to achieve remission, or loss to follow-up during chemotherapy. Multivariate logistic regression adjusted by age, ethnicity, marital status and the reference center location showed that when the distance between residence and GTN-RC was ≥56 km, there was an increase in the occurrence of metastatic disease (relative risk - RR:3.27; 95%CI:2.20-4.85), need for multiagent chemotherapy (RR:1.36; 95%CI:1.05-1.76), loss to follow-up during chemotherapy (RR:4.52; 95CI:1.93-10.63), occurrence of chemoresistance (RR:4.61; 95%CI:3.07-6.93), relapse (RR:10.27; 95%CI:3.08-34.28) and death due to GTN (RR:3.62; 95%CI:1.51-8.67).

Conclusions: The distance between the patient's residence and the GTN-RC is a risk factor for unfavorable outcomes, including death from this disease. It is crucial to guarantee these patients get prompt access to the GTN-RC and receive follow-up support.

Keywords: Chemotherapy; Gestational trophoblastic disease; Gestational trophoblastic neoplasia; Metastasis; Referral center; Travel distance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brazil / epidemiology
Cohort Studies
Female
Gestational Trophoblastic Disease* / pathology
Humans
Neoplasm Recurrence, Local*
Pregnancy
Retrospective Studies
Risk Factors