Abstract
BackgroundThere are three main therapeutic strategies, namely expectant management (dilation and curettage only), prophylactic chemotherapy and prophylactic total hysterectomy for treating older women with complete hydatidiform mole (CHM). However, the scientific community has so far, not unanimously accepted the above-mentioned methods. The objective of this study was to evaluate the effectiveness of these therapeutic strategies in preventing post-molar gestational trophoblastic neoplasia (GTN) pertaining to patients with CHM who were at least 40 years old.MethodsHundred and seventy-one patients from our hospital who had histologically been diagnosed of CHM and underwent treatment from January 2004 to December 2013 were included. All patients were followed continuously for a minimum of 2 years after which relevant clinical data were extracted and analysed.ResultsAll patients were divided to three groups. Group 1 consisted of 124 patients, treated by expectant management, and the incidence of post-molar GTN was 37.1%. Group 2 included 12 patients who received prophylactic chemotherapy, with an incidence of 41.7%. The remaining 35 patients, Group 3, underwent prophylactic total hysterectomy, with the lowest incidence of 11.4%. A significantly lower incidence was noted in group 3 as compared to group 1 (P = 0.004). GTN patients who received prophylactic chemotherapy required, on average, longer time to be diagnosed of GTN and had higher probability of chemotherapy resistance (P = 0.031 and P = 0.024).ConclusionsThis retrospective analysis showed that prophylactic total hysterectomy was the most effective therapeutic strategy for treating CHM in women at least 40 years old of age.
Highlights
There are three main therapeutic strategies, namely expectant management, prophylactic chemotherapy and prophylactic total hysterectomy for treating older women with complete hydatidiform mole (CHM)
Gestational trophoblastic disease is a spectrum of interrelated diseases ranging from complete and partial hydatidiform mole to life-threatening gestational trophoblastic neoplasia (GTN), among which complete hydatidiform mole (CHM) is the most common form
Most of the patients were parous with a mean parity of 1.2, while mean gestational age was 9.5 weeks. 94.2% of the patients were diagnosed during first trimester and 5.8% during the second trimester. 60.9% of the patients had an initial human chorionic gonadotropin (hCG) level of greater than 100,000 IU/L before evacuation, 24.4% had an enlarged uterine size over gestational age, while 13.3% had a theca lutein cyst greater than 6 cm
Summary
There are three main therapeutic strategies, namely expectant management (dilation and curettage only), prophylactic chemotherapy and prophylactic total hysterectomy for treating older women with complete hydatidiform mole (CHM). The objective of this study was to evaluate the effectiveness of these therapeutic strategies in preventing post-molar gestational trophoblastic neoplasia (GTN) pertaining to patients with CHM who were at least 40 years old. Increase in maternal age, which is the most frequently cited risk factor, has a proportional effect on the incidence of post-molar GTN [3, 4]. Considering the age-incidence relationship involved, some centres might choose to offer prophylactic hysterectomy either instead of evacuation or following evacuation of a complete mole to reduce the risk of developing GTN in older patients who have completed their families. Occasional centres may recommend prophylactic chemotherapy after molar evacuation as an alternative way to prevent post-molar GTN. Few of the above-mentioned studies targeted patients who are at least 40 years old
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