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Eur J Obstet Gynecol Reprod Biol. 2018 Apr;223:50-55. doi: 10.1016/j.ejogrb.2018.02.001. Epub 2018 Feb 15.

Does a human chorionic gonadotropin level of over 20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole constitute an indication for chemotherapy for gestational trophoblastic neoplasia?

Author information

1
Postgraduate Program in Perinatal Health, Rio de Janeiro Trophoblastic Disease Center, Maternity School, Federal University of Rio de Janeiro and Antonio Pedro University Hospital at Fluminense Federal University, Rio de Janeiro, Brazil; Postgraduate Program in Maternal and Child Health, Fluminense Federal University, Niterói, Brazil. Electronic address: antonio.braga@ufrj.br.
2
Postgraduate Program in Maternal and Child Health, Fluminense Federal University, Niterói, Brazil.
3
Postgraduate Program in Dentistry, Federal University of Santa Maria, Santa Maria, RS, Brazil.
4
Goiás Trophoblastic Disease Center, Goiás Federal University, Goiânia, Brazil.
5
New England Trophoblastic Disease Center, Donald P. Goldstein, MD. Trophoblastic Tumor Registry, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute/Harvard Cancer Center, Harvard Medical School, Boston, United States.
6
Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College of London, London, UK.

Abstract

OBJECTIVE:

To evaluate whether a human chorionic gonadotropin (hCG) level ≥20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole (CHM) is an appropriate indicator for initiating chemotherapy for the treatment of gestational trophoblastic neoplasia (GTN).

STUDY DESIGN:

Historical database review of 1228 women with CHM who received treatment and follow-up between January 2000 and June 2013 at four Brazilian trophoblastic disease centers. The primary outcome measure was the progression from CHM to GTN. The secondary outcomes were the occurrence of uterine perforation, staging of GTN, WHO/FIGO risk score, and treatment (use of single- or multiagent chemotherapy).

RESULTS:

An hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM, while occurring in only 6.1% of women, was the most important risk factor for the development of postmolar GTN (adjusted RR = 5.83; p < 0.01; CI: 3.47-9.79), with a sensitivity of 36.8%, a specificity of 98.6%, a positive predictive value of 80%, and a negative predictive value of 91.1%. On the other hand, there were no differences in postmolar GTN stage, prognostic score, or need for multiagent chemotherapy relative to hCG level ≥20,000 IU/L versus <20,000 IU/L.

CONCLUSIONS:

Although hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM was very predictive of development of post-molar GTN, delay in treatment until hCG plateau or increase did not affect outcomes, with no uterine perforations or treatment failures.

KEYWORDS:

Brazil; Gestational trophoblastic neoplasia; Human chorionic gonadotropin; Hydatidiform mole; Molar pregnancy

PMID:
29477553
DOI:
10.1016/j.ejogrb.2018.02.001
[Indexed for MEDLINE]

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