Combined analysis of clinical features, human chorionic gonadotropin (hCG) value, and hCG ratios for early prediction of postmolar gestational trophoblastic neoplasia
Tóm tắt
To investigate factors predicting postmolar gestational trophoblastic neoplasia (GTN) by combined analysis of clinical features, human chorionic gonadotropin (hCG) value, and hCG ratios. This retrospective study enrolled patients with histopathologically proven molar pregnancy. Patients lost to follow-up before remission or developing postmolar GTN were excluded. Demographic and clinical characteristics and hCG data obtained before and after molar evacuation were collected. Area under the receiver operating characteristic curve (AUC) analysis was used to identify the hCG and hCG ratio cutoff values that predict postmolar GTN. Multivariate analysis was employed to identify independent predictors of GTN. There were 113 complete moles, 11 partial moles, and 52 unspecified moles included in the final analysis. Of the 176 cases, 90 achieved remission and 86 developed post-molar GTN. The incidence of postmolar GTN was 48.9%, with a median time to GTN development of 5 weeks. Univariate analysis showed age, molar evacuation performed elsewhere, pre-evacuation hCG, hCG at 2nd week post-evacuation, and ratio of hCG at 2nd week post-evacuation to post-evacuation hCG significantly predict GTN. Multivariate analysis revealed an hCG value ≥ 1400 IU/L at 2nd week post-evacuation (AUC: 0.92, aOR: 6.51, 95% CI 1.28–33.16; p = 0.024) and a ratio of hCG at 2nd week post-evacuation to post-evacuation hCG of ≥ 0.02 (AUC: 0.88, aOR: 12.27, 95% CI 2.15–70.13; p = 0.005) to independently predict GTN. An hCG value ≥ 1400 IU/L at 2nd week post-evacuation and a ratio of hCG at 2nd week post-evacuation to post-evacuation hCG of ≥ 0.02 independently and reliably predict postmolar GTN.
Tài liệu tham khảo
Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C (2003) Epidemiology and aetiology of gestational trophoblastic diseases. Lancet Oncol 4:670–678
Asmar FTC, Braga-Neto AR, de Rezende-Filho J, Villas-Boas JMS, Charry RC, Maesta I (2017) Uterine artery Doppler flow velocimetry parameters for predicting gestational trophoblastic neoplasia after complete hydatidiform mole, a prospective cohort study. Clinics 72:284–288
Ayhan A, Tuncer ZS, Halilzade H, Kucukali T (1996) Predictors of persistent disease in women with complete hydatidiform mole. J Reprod Med 41:591–594
Bagshawe KD, Dent J, Webb J (1986) Hydatidiform mole in England and wales 1973–83. Lancet 2:673–677
Bakhtiyari M, Mirzamoradi M, Kimyaiee P, Aghaie A, Mansournia MA, Ashrafi-Vand S, Sarfjoo FS (2015) Postmolar gestational trophoblastic neoplasia: beyond the traditional risk factors. Fertil Steril 104:649–654
Berkowitz RS, Im SS, Bernstein MR, Goldstein DP (1998) Gestational trophoblastic disease. subsequent pregnancy outcome, including repeat molar pregnancy. J Reprod Med 43:81–86
Berkowitz RS, Goldstein DP (2009) Clinical practice. molar pregnancy. N Engl J Med 360:1639–1645
Berkowitz RS, Goldstein DP (2009) Current management of gestational trophoblastic diseases. Gynecol Oncol 112:654–662
Berkowitz RS, Goldstein DP (2013) Current advances in the management of gestational trophoblastic disease. Gynecol Oncol 128:3–5
Braga A, Maesta I, Rocha Soares R, Elias KM, Custodio Domingues MA, Barbisan LF, Berkowitz RS (2016) Apoptotic index for prediction of postmolar gestational trophoblastic neoplasia. Am J Obstet Gynecol 215(336):331–336
Cavoretto P, Cioffi R, Mangili G, Petrone M, Bergamini A, Rabaiotti E, Valsecchi L, Candiani M, Seckl MJ (2020) A pictorial ultrasound essay of gestational trophoblastic disease. J Ultrasound Med Off J Am Inst Ultrasound Med 39:597–613
Committee FO (2000) FIGO staging for gestational trophoblastic neoplasia, 2000 FIGO oncology committee. Int J Gynaecol Obstet Off Organ Intern Fed Gynaecol Obstet 77(3):285–287
Diver EJ, Horowitz NS, Goldstein DP, Bernstein M, Berkowitz RS, Growdon WB (2016) Timing of referral to the New England trophoblastic disease center: does referral with molar pregnancy versus postmolar gestational trophoblastic neoplasia affect outcomes? J Reprod Med 61:187–191
Elias KM, Shoni M, Bernstein M, Goldstein DP, Berkowitz RS (2012) Complete hydatidiform mole in women aged 40 to 49 years. J Reprod Med 57:254–258
Garavaglia E, Gentile C, Cavoretto P, Spagnolo D, Valsecchi L, Mangili G (2009) Ultrasound imaging after evacuation as an adjunct to beta-hCG monitoring in posthydatidiform molar gestational trophoblastic neoplasia. Am J Obstet Gynecol 200(417):e411-415
Hasanzadeh M, Sharifi N, Esmaieli H, Daloee MS, Tabari A (2013) Immunohistochemical expression of the proliferative marker Ki67 in hydatidiform moles and its diagnostic value in the progression to gestational trophoblastic neoplasia. J Obstet Gynaecol Res 39:572–577
Hoeijmakers YM, Eysbouts YK, Massuger L, Dandis R, Inthout J, van Trommel NE, Ottevanger PB, Thomas CMG, Sweep F (2021) Early prediction of post-molar gestational trophoblastic neoplasia and resistance to methotrexate, based on a single serum human chorionic gonadotropin measurement. Gynecol Oncol 163:531–537
Jeffers MD, O’Dwyer P, Curran B, Leader M, Gillan JE (1993) Partial hydatidiform mole: a common but underdiagnosed condition. A 3-year retrospective clinicopathological and DNA flow cytometric analysis. Intern J Gynecol Pathol Off J Intern Soc Gynecol Pathol 12:315–323
Kang WD, Choi HS, Kim SM (2012) Prediction of persistent gestational trophoblastic neoplasia: the role of hCG level and ratio in 2 weeks after evacuation of complete mole. Gynecol Oncol 124:250–253
Khoo SK, Baartz D, Sidhu M, Yip WL, Tripcony L (2009) Analysis of risk factors for persistent gestational trophoblastic disease. Aust N Z J Obstet Gynaecol 49:657–659
Kim BW, Cho H, Kim H, Nam EJ, Kim SW, Kim S, Kim YT, Kim JH (2012) Human chorionic gonadotrophin regression rate as a predictive factor of postmolar gestational trophoblastic neoplasm in high-risk hydatidiform mole: a case-control study. Eur J Obstet Gynecol Reprod Biol 160:100–105
Kim SJ, Na YJ, Jung SG, Kim CJ, Bae SN, Lee C (2007) Management of high-risk hydatidiform mole and persistent gestational trophoblastic neoplasia: the Korean experience. J Reprod Med 52:819–830
Lybol C, Sweep FC, Ottevanger PB, Massuger LF, Thomas CM (2013) Linear regression of post-evacuation serum human chorionic gonadotropin concentrations predicts postmolar gestational trophoblastic neoplasia. Intern J Gynecol Cancer Off J Intern Gynecol Cancer Soc 23:1150–1156
Menczer J, Schreiber L, Berger E, Golan A, Levy T (2007) Assessment of Her-2/neu expression in hydatidiform moles for prediction of subsequent gestational trophoblastic neoplasia. Gynecol Oncol 104:675–679
Mousavi AS, Karimi S, Modarres Gilani M, Akhavan S, Rezayof E (2014) Does post-evacuation beta -human chorionic gonadotropin level predict the persistent gestational trophoblastic neoplasia? ISRN Obstet Gynecol 2014:494695
Ngan HYS, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, Lurain JR, Massuger L (2018) Update on the diagnosis and management of gestational trophoblastic disease. Intern J Gynaecol Obstet Off Organ Intern Fed Gynaecol Obstet 143(Suppl 2):79–85
Palmer JR (1994) Advances in the epidemiology of gestational trophoblastic disease. J Reprod Med 39:155–162
Sun P, Wu Q, Ruan G, Zheng X, Song Y, Zhun J, Wu L, Gotlieb WH (2016) Expression patterns of maspin and mutant p53 are associated with the development of gestational trophoblastic neoplasia. Oncol Lett 12:3135–3142
Vanichtantikul A, Hodge KG, Somparn P, Saethang T, Triratanachat S, Pisitkun T, Lertkhachonsuk R (2019) Proteomic identification of predictive biomarkers for malignant transformation in complete hydatidiform moles. Placenta 77:58–64
Wang Q, Fu J, Hu L, Fang F, Xie L, Chen H, He F, Wu T, Lawrie TA (2017) Prophylactic chemotherapy for hydatidiform mole to prevent gestational trophoblastic neoplasia. Cochrane Database Syst Rev 9:CD007289
Wolfberg AJ, Berkowitz RS, Goldstein DP, Feltmate C, Lieberman E (2005) Post-evacuation hCG levels and risk of gestational trophoblastic neoplasia in women with complete molar pregnancy. Obstet Gynecol 106:548–552
Yedema KA, Verheijen RH, Kenemans P, Schijf CP, Borm GF, Segers MF, Thomas CM (1993) Identification of patients with persistent trophoblastic disease by means of a normal human chorionic gonadotropin regression curve. Am J Obstet Gynecol 168:787–879