Postevacuation hCG levels and risk of gestational trophoblastic neoplasia in women with complete molar pregnancy

被引:41
作者
Wolfberg, AJ
Berkowitz, RS
Goldstein, DP
Feltmate, C
Lieberman, E
机构
[1] Massachusetts Gen Hosp, Dept Obstet & Gynecol, Brigham & Womens Hosp, Boston, MA 02115 USA
[2] Massachusetts Gen Hosp, New England Trophoblast Dis Ctr, Boston, MA 02114 USA
[3] Massachusetts Gen Hosp, Div Gynecol Oncol, Boston, MA 02114 USA
[4] Massachusetts Gen Hosp, Div Clin & Epidemiol Res, Boston, MA 02114 USA
[5] Massachusetts Gen Hosp, Dept Obstet, Boston, MA 02114 USA
[6] Harvard Univ, Sch Med, Boston, MA USA
[7] Dana Farber Canc Inst, Gillette Ctr Womens Canc, Boston, MA 02115 USA
关键词
D O I
10.1097/01.AOG.0000174583.51617.25
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objectives: Women diagnosed with complete hydatidi-form molar pregnancy are at 15% to 28% risk of developing persistent gestational trophoblastic neoplasia (GTN) requiring further management with chemotherapy. Our objective was to develop human chorionic gonadotropin (hCG) criteria that establish a patient's risk of developing persistent GTN or achieving remission from their baseline risk within a few weeks of molar evacuation. Methods: We used a database from the New England Trophoblastic Disease Center to analyze hCG levels from 1,029 women with complete molar pregnancies. We conducted a retrospective cohort study using data from 1973 to 2001. Results: Women whose hCG level declined below 50 mIU/mL during their follow-up were found to be at no more than 1.11% risk for developing persistent GTN, irrespective of when this level was reached. Women whose hCG levels was below 200 mIU/mL in the fourth week after evacuation (59.80% of all women), or below 100 mIU/mL in the sixth week after evacuation (65.8%, of all women), had a risk of persistence below 90%. hCG levels above 2,000 mIU/mL in the fourth week after evacuation (13.3% of women) were associated with a 63.8% risk of developing persistent disease. Conclusion: These data may allow clinicians to evaluate the risk of persistence that their patients with complete molar pregnancy have based on early hCG, results after molar evacuation. In the fourth week after molar evacuation, 59.8%. of women may be counseled that theit, risk of developing persistent GTN is substantially reduced from their baseline, whereas of women may be warned that their risk of developing persistent GTN is greater than 501%.
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页码:548 / 552
页数:5
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