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Studying changes in the incidence, diagnosis and management of GTD: the South Korean model.

OBJECTIVE
To evaluate the changing epidemiologic picture and clinical characteristics of gestational trophoblastic disease (GTD) in South Korea over the past 5 decades.


STUDY DESIGN
Patient data were collected from 37 hospitals nationwide, the Korean Research Institute of Trophoblastic Disease registry and CHA University Comprehensive Gynecologic Cancer Center from the years of 1970s through the year 2002. Demographic data, pretreatment evaluation, treatment modality, chemotherapeutic regimen and their results according to the clinical International Federation of Gynecology and Obstetrics classification and World Health Organization prognostic score were analyzed. Management of high-risk gestational trophoblastic tumor (GTT) was reviewed in depth.


RESULTS
The nationwide incidence of hydatidiform mole and GTT dropped from 40.0 per 1,000 deliveries and 5.0 per 1,000 deliveries, respectively, in the 1970s to 2.0 per 1,000 deliveries and 0.5 per 1,000 deliveries, respectively, in the 1990s. The rate of decline was slower in 2000-2002. Significant changes were also noted in age distribution, interval between the preceding pregnancy and disease, gravidity and parity, and distribution of low- and high-risk groups of GTT.


CONCLUSION
The dramatic improvement in GTD over the past 5 decades in South Korea can be attributed to the following factors: refinement in terminology and classification, advances in pretreatment evaluation, development of effective chemotherapeutic agents, application of multimodal treatment and novel chemoagents for high-risk GTT.