Gestational trophoblastic neoplasia in the Western Brazilian Amazon: Patient characteristics and impact of referral center restructuring.
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This ambispective cohort study of 29 women with gestational trophoblastic neoplasia treated at a referral center in the Western Brazilian Amazon (2011-2022) asked whether restructuring the center improved treatment and follow-up. After restructuring, the authors found fewer chemotherapy regimen changes and significantly fewer patients lost to post-molar follow-up, though mortality (17%) did not differ between periods. Deaths occurred in high-risk, advanced-stage patients with treatment delays, most often from hemorrhage due to vaginal metastases, underscoring the value of organized referral pathways and early diagnosis in resource-limited settings.
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