MORTALITY FACTORS IN HIGH AND ULTRA-HIGH-RISK GESTATIONAL TROPHOBLASTIC NEOPLASIA AT MOI TEACHING & REFERRAL HOSPITAL: A DECADE-LONG OBSERVATION IN KENYA
Description
ABSTRACT Background: Prior to the advent of effective chemotherapy, gestational trophoblastic neoplasia (GTN) was almost invariably fatal. The key to a favorable prognosis hinges on early detection and the provision of appropriate and timely treatment. The effects of the literature from low-middle-income countries (LMICs) on GTN mortality remain inadequately explored. This study aimed to provide an overview of mortality among GTN patients in a tertiary hospital in Kenya and to identify factors contributing to treatment failure. Methods: A 10-year retrospective review of a single-center GTN database and patient medical records was conducted (January 2013 - December 2022). Data on demographic characteristics, clinical presentation, treatment modalities, and outcomes were extracted. Logistic regression analysis was used to identify independent predictors of GTN mortality. Survival probabilities were estimated using the Kaplan‒Meier method. The study was performed at the Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Results: Of the 98 patients analyzed, 31.6% (n=31) died. Most of these patients who died (71.4%) were referred from other health facilities. A substantial proportion (83.9%) of deceased women had advanced disease stages (FIGO 3 and 4), and 51.6% were classified as ultrahigh risk. Early deaths, within the first four weeks of treatment, occurred in 48.4% of all mortalities. Treatment delay was observed in 45.9% of patients. GTN complications were recorded in 61.2% of the patients. Bone marrow suppression (35.7%), electrolyte derangement (32.7%), and renal function derangement (31.6%) were frequent. An Eastern Cooperative Oncology Group (ECOG) performance status >1 (AOR 5.11 (95% CI: 1.543-19.218)), complications from either disease or treatment (AOR 5.112 95% CI: 1.087-24.045) and HCG levels ≥100000 (AOR 4.733 95% CI: 1.278-17.526) were significantly associated with an increased risk of mortality. Conclusion: The mortality rate from GTN in this setting is high. Patients primarily present with advanced-stage disease and are classified as ultrahigh risk. There is a need to enhance healthcare systems to facilitate timely access to GTN care to reduce GTN-related mortality.