{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:49:23Z","timestamp":1785934163970,"version":"3.56.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012544","name":"China Medical University, Taiwan","doi-asserted-by":"publisher","award":["CMU108-YTY-01, 10951M8*, NSTC 112-2636-E-039-001, NSTC 113-2124-M-039-002"],"award-info":[{"award-number":["CMU108-YTY-01, 10951M8*, NSTC 112-2636-E-039-001, NSTC 113-2124-M-039-002"]}],"id":[{"id":"10.13039\/501100012544","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the clinical characteristics, metastatic patterns, and treatment outcomes of gestational choriocarcinoma in Mongolia, with a particular focus on the impact of etoposide\u2013methotrexate\u2013actinomycin D\/cyclophosphamide\u2013vincristine (EMA\/CO) chemotherapy implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted including 66 patients diagnosed with gestational choriocarcinoma between 2011 and 2025. Patients were stratified based on FIGO stage and metastatic status. Clinical features, antecedent pregnancy, and treatment outcomes were analyzed. Comparisons between pre-implementation (2011\u20132017) and post-implementation (2018\u20132025) cohorts were performed using independent t-test, chi-square test, or Fisher\u2019s exact test as appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 66 patients, 42.4% (n = 28) had non-metastatic disease (FIGO stage I), while 57.6% (n = 38) presented with metastatic disease (FIGO stages II\u2013IV). Vaginal bleeding was the most common presenting symptom (84.8%). The lungs were the most frequent site of metastasis. Following implementation of the EMA\/CO chemotherapy regimen in 2018, higher complete remission rates and lower observed mortality were observed in the post-implementation cohort. Complete remission increased from 69.7% (23\/33) to 97.0% (32\/33) (p = 0.006), while disease-related mortality decreased from 30.3% (10\/33) to 3.0% (1\/33) (p = 0.006). Chemoresistance and relapse rates also decreased, although these differences were not statistically significant. Additional interventions, including surgery for residual disease and radiotherapy for brain or lung metastases, were applied when indicated. Despite overall improvements, metastatic disease remained a key determinant of prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients treated after 2018 demonstrated higher complete remission rates and lower observed mortality compared with those treated before 2018. However, due to the retrospective design, absence of adjusted outcome analysis, and baseline differences between treatment-era cohorts, these findings should be interpreted cautiously. Early diagnosis, routine serum \u03b2-hCG surveillance, timely referral, and standardized management remain essential for optimizing outcomes in gestational choriocarcinoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1863040","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:23:32Z","timestamp":1784262212000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment outcomes of gestational choriocarcinoma before and after EMA\/CO introduction in Mongolia: a 15-year retrospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Ulziijargal","family":"Sukhbat","sequence":"first","affiliation":[{"name":"Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gandolgor","family":"Batsuuri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mungun guur, Hospital","place":["Ulaanbaatar, Mongolia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eiko","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Healthcare Administration, Nagoya University Graduate School of Medicine","place":["Nagoya, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terkhen","family":"Turbat","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mongolian National University of Medical Sciences","place":["Ulaanbaatar, Mongolia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oyujin","family":"Ulziibaatar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mongolian National University of Medical Sciences","place":["Ulaanbaatar, Mongolia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baatarkhuu","family":"Oidov","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Mongolian National University of Medical Sciences","place":["Ulaanbaatar, Mongolia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ita Daryanti","family":"Saragih","sequence":"additional","affiliation":[{"name":"College of Information Sciences and Technology, Pennsylvania State University, University Park","place":["Pennsylvania, PA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Namuun","family":"Ganzul","sequence":"additional","affiliation":[{"name":"Deparment of Gynecologic Oncology, National Cancer Center","place":["Ulaanbaatar, Mongolia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yen-Liang","family":"Liu","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University","place":["Taichung, Taiwan"]},{"name":"Master Program for Biomedical Engineering, College of Biomedical Engineering, China Medical University","place":["Taichung, Taiwan"]},{"name":"Cancer Biology and Precision Therapeutics Center, China Medical University","place":["Taichung, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jargalsaikhan","family":"Badarch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mongolian National University of Medical Sciences","place":["Ulaanbaatar, Mongolia"]},{"name":"Mongolia-Japan Hospital, Mongolian National University of Medical Sciences","place":["Ulaanbaatar, Mongolia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1159\/000291524","article-title":"Successful treatment of a high-risk 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