Incidence Of Gestational Trophoblastic Neoplasia Research Articles

Relationship Between Risk Factors and The Incidence of Gestational Trophoblastic Neoplasia at RSUP Dr. M. Djamil Padang Year 2019-2021

Relationship Between Risk Factors and The Incidence of Gestational Trophoblastic Neoplasia at RSUP Dr. M. Djamil Padang Year 2019-2021

Delivery management of a complete hydatidiform mole and co-existing viable fetus: A meta-analysis and systematic review

ObjectiveA twin pregnancy with a complete hydatidiform mole and co-existing viable fetus (CHMCF) is an exceedingly rare obstetric complication with few data related to perinatal treatment. This study determined the optimal timing of pregnancy termination and mode of delivery in women with CHMCF and a viable fetus. MethodsThe articles published involving CHMCF and a viable fetus from 1967 to 31 December 2020 in the PubMed and EMBASE databases were systematically reviewed. Observational cohort studies with three or more cases identified and data on delivery management were selected. The articles were analyzed independently for full text and the data were integrated. The timing of pregnancy termination and mode of delivery were calculated using Review Manager 5.4.1. ResultsThere were 192 reports involving CHMCF; 209 cases had a viable fetus. According to the inclusion criteria, there were 6 case series, including 72 cases that were eligible for the analysis. The average rate of live births was 34.4%. The average duration of pregnancy was 34 weeks, ranging from 25 to 41 weeks. From 2000–2017 the live birth rate was increased year-after-year. Specifically, the live birth rate was16.7% in 2000, 33.3% in 2012, and 50% in 2017. Fifty-two cases (72.2%) had cesarean sections and 20 cases (27.8%) had vaginal deliveries. The incidence of gestational trophoblastic neoplasia was not significantly different between the two modes of delivery. ConclusionsIdeally, a twin pregnancy with a complete hydatidiform mole co-existing with a viable fetus is managed by an obstetrician, pediatrician, and oncologist. Appropriate timing of pregnancy termination and mode of delivery are related to the pregnancy outcome.

Surveillance for gestational trophoblastic neoplasia following molar pregnancy: a cost-effectiveness analysis

Historically, published guidelines for care after molar pregnancy recommended monitoring human chorionic gonadotropin levels for the development of gestational trophoblastic neoplasia until normal and then for 6 months after the first normal human chorionic gonadotropin. However, there are little data underlying such recommendations, and recent evidence has demonstrated that gestational trophoblastic neoplasia diagnosis after human chorionic gonadotropin normalization is rare. We sought to estimate the cost-effectiveness of alternative strategies for surveillance for gestational trophoblastic neoplasia after human chorionic gonadotropin normalization after complete and partial molar pregnancy. A Markov-based cost-effectiveness model, using monthly cycles and terminating after 36 months/cycles, was constructed to compare alternative strategies for asymptomatic human chorionic gonadotropin surveillance after the first normal (none; monthly testing for 1, 3, 6, and 12 months; or every 3-month testing for 3, 6, and 12 months) for both complete and partial molar pregnancy. The risk of reduced surveillance was modeled by increasing the probability of high-risk disease at diagnosis. Probabilities, costs, and utilities were estimated from peer-reviewed literature, with all cost data applicable to the United States and adjusted to 2020 US dollars. The primary outcome was cost per quality-adjusted life year ($/quality-adjusted life year) with a $100,000/quality-adjusted life year willingness-to-pay threshold. Under base-case assumptions, we found no further surveillance after the first normal human chorionic gonadotropin to be the dominant strategy from both the healthcare system and societal perspectives, for both complete and partial molar pregnancy. After complete mole, this strategy had the lowest average cost (healthcare system, $144 vs maximum $283; societal, $152 vs maximum $443) and highest effectiveness (2.711 vs minimum 2.682 quality-adjusted life years). This strategy led to a slightly higher rate of death from gestational trophoblastic neoplasia (0.013% vs minimum 0.009%), although with high costs per gestational trophoblastic neoplasia death avoided (range, $214,000 to >$4 million). Societal perspective costs of lost wages had a greater impact on frequent surveillance costs than rare gestational trophoblastic neoplasia treatment costs, and no further surveillance was more favorable from this perspective in otherwise identical analyses. No further surveillance remained dominant or preferred with incremental cost-effectiveness ratio of <$100,000 in all analyses for partial mole, and most sensitivity analyses for complete mole. Under the assumption of no disutility from surveillance, surveillance strategies were more effective (by quality-adjusted life year) than no further surveillance, and a single human chorionic gonadotropin test at 3 months was found to be cost-effective after complete mole with incremental cost-effectiveness ratio of $53,261 from the healthcare perspective, but not from the societal perspective (incremental cost-effectiveness ratio, $288,783). Largely owing to the rare incidence of gestational trophoblastic neoplasia after human chorionic gonadotropin normalization after molar pregnancy, prolonged surveillance is not cost-effective under most assumptions. It would be reasonable to reduce, and potentially eliminate, current recommendations for surveillance after human chorionic gonadotropin normalization after molar pregnancy, particularly among partial moles. With any reduction in surveillance, patients should be counseled on symptoms of gestational trophoblastic neoplasia and established in routine gynecologic care.

Assessment of current follow-up for complete molar pregnancies: A single centre review.

Current guidelines recommend that resolution of a complete molar pregnancy (CMP) can only be confirmed once a negative β-human chorionic gonadotropin (β-hCG) has been maintained for six months following uterine surgical evacuation. However, multiple studies have found that the risk of developing gestational trophoblastic neoplasia (GTN) once a negative β-hCG had been obtained is negligible, which suggests that a shorter follow-up may be reasonable. To determine the trend in β-hCG following diagnosis of a CMP and the incidence of GTN, in a single unit. All patients presenting to the tertiary hospital, Royal Prince Alfred Hospital Early Pregnancy Assessment Service (RPAH EPAS), with a histopathological diagnosis of a CMP between 2010 and 2017 were included. Data collected included age, parity, β-hCG at diagnosis, subsequent β-hCG levels, incidence of GTN and treatment required. Sixty-seven patients were diagnosed with CMP between January 2010 and July 2017 through RPAH EPAS. The mean age of women diagnosed with a CMP was 33years. None of the 40 patients who spontaneously achieved a negative β-hCG and completed their six months follow-up had a subsequent rise in β-hCG. The median number of days from surgical evacuation to normalisation of β-hCG was 55.5days. Sixteen out of 67 patients who had a CMP required further management for persistent GTN. None of these patients achieved a negative β-hCG prior to further management. Consideration could be made to decreasing the period of β-hCG monitoring for women who achieve a spontaneous negative β-hCG following surgical evacuation of a CMP.

Response to Chemotherapy in Patients with Gestational Trophoblastic Neoplasia in A Tertiary Hospital in Indonesia

Background: The incidence of gestational trophoblastic neoplasia (GTN) is high in Indonesia. Based on the FIGO prognostic score, GTN is classified into low-risk and high-risk categories. The high-risk group requires multidrug chemotherapy whereas the low-risk group requires single-drug chemotherapy. Response to chemotherapy would reflect the remission rate. The aim of this study was to describe the response to chemotherapy in GTN patients Methods: This was a cross-sectional descriptive retrospective study on medical records of patients with GTN treated in Dr. Hasan Sadikin General Hospital during the period of 2016 to 2018. The inclusion criteria were GTN patients who received &gt; 3 cycles of chemotherapy while the exclusion criteria were incomplete, inaccessible, or missing data. Data were collected on patient’s age, parity, history of previous pregnancy, pregnancy-therapy interval, tumor size, number and location of metastases, and history of failed chemotherapy. Results: Of the189 medical records of the GTN patient collected, only 88 met the inclusion criteria, (63.6% low risk and 36.4% high risk). Most patients were responsive to chemotherapy (61.4%), aged&lt;40 years old, multiparity, tumor size &gt;5 cm, had 4 month interval from previous pregnancy &lt;4 months, had a history of molar pregnancy, had no metastases, and no previous failed chemotherapy. Conclusion: The chemotherapy response in gestational trophoblastic neoplasm patients is fairly good with most patients are in the low-risk groups. Specific tumor markers used in early diagnosis of GTN may play a major role.

The management of hydatidiform mole using prophylactic chemotherapy and hysterectomy for high-risk patients decreased the incidence of gestational trophoblastic neoplasia in Vietnam: a retrospective observational study.

ABSTRACTThe management of hydatidiform mole (HM) and the incidence of post-molar gestational trophoblastic neoplasia (GTN) in Vietnam has not been reported to date. This study aimed to study the incidence of HM and post-molar GTN and identify factors associated with post-molar GTN at a tertiary hospital in Vietnam. Five hundred and eighty-four patients who were treated for HM at Tu Du Hospital between January and December 2010 were included in this study. The mean age and gestational age at the first evacuation were 28.8 years old and 11.0 weeks, respectively. After the initial evacuation and pathological examination, 87 patients who were older than 40 or did not wish to have children underwent a hysterectomy, while the others underwent second curettage. All 472 patients who had human chorionic gonadotropin (hCG) ≥ 100,000 IU/L before treatment received one cycle of methotrexate with folinic acid as prophylactic chemotherapy. The incidence of HM was 11.1 per 1,000 deliveries; 47 patients (8.0%) developed post-molar GTN. Gestational week, hCG level at one week after the first evacuation, and pathological remnants were significantly associated with the development of post-molar GTN. The results of this study suggest that prophylactic chemotherapy and hysterectomy may be useful for high-risk HM patients to reduce post-molar GTN in settings in which the risk of post-molar GTN and loss to follow-up after HM are greater and hCG measurements and appropriate GTN treatments are unavailable. However, future studies on the long-term outcomes and side effects of prophylactic therapies on HM are required.

ABO blood type compatibility is not a risk factor for gestationaltrophoblastic neoplasia development from androgenetic completehydatidiform moles.

Complete hydatidiform moles (CHMs) are allografts to patients in terms of an androgenetic origin. Thus, some immunological reactions may be involved in the development of gestational trophoblastic neoplasia (GTN) from CHMs. This study aimed to evaluate the effect of ABO blood group on the prognosis of androgenetic CHMs. A total of 129 patients who were diagnosed as having CHMs based on multiplex short tandem repeat polymorphism analysis were included. The ABO blood types of molar tissues were determined by single-nucleotide polymorphisms in the ABO gene using a high-resolution melting assay. The incidence of GTN was compared based on ABO compatibility between the patients and their molar tissues. The overall incidence of GTN was 17.1% (22/129). Gestational trophoblastic neoplasia occurred in 10.8% (4/37), 14.8% (8/54), 22.2% (6/27), and 36.4% (4/11) of type O, A, B, and AB patients, respectively. Type AB patients tended to develop GTN compared with other blood type patients (P=.093). In ABO type of CHMs, GTN occurrence was not significantly different as it was 16.4% (10/64), 16.0% (8/50), and 22.2% (4/18) for types O, A, and B, respectively (P=.854). According to the ABO incompatibility between patients and molar tissues, GTN occurred in 19.1% (18/94) of the compatible cases and 11.4% (4/35) of the incompatible cases; the occurrence was not significantly different (P=.223). Patients with type AB tended to develop GTN. However, ABO compatibility between patients and molar tissues had no relationship with GTN occurrence.

Gestational Trophoblastic Neoplasia After Human Chorionic Gonadotropin Normalization Following Molar Pregnancy: A Systematic Review and Meta-analysis.

To estimate the incidence of gestational trophoblastic neoplasia following complete and partial molar pregnancy after reaching normal human chorionic gonadotropin (hCG) levels to guide evidence-based follow-up recommendations. MEDLINE, EMBASE, Web of Science, POPLINE, Cochrane, and ClinicalTrials.gov were searched from inception to November 2018, using the intersection of "gestational trophoblastic disease," "molar pregnancy," and "human chorionic gonadotropin" themes. Search results were screened to identify cohort studies of molar pregnancy reporting gestational trophoblastic neoplasia development, with at least 6 months of intended normal hCG follow-up. Two reviewers independently identified articles for inclusion. Data were extracted using a standardized form. For meta-analysis, cumulative incidence of gestational trophoblastic neoplasia, with CIs by the Agresti-Coull method, and pooled risk ratios (RRs) comparing complete and partial mole were calculated. Among the 19 eligible studies that reported adequate data for inclusion in the primary meta-analysis, we found low incidence of gestational trophoblastic neoplasia after normal hCG level following both complete mole (64/18,357, 0.35%, 95% CI 0.27-0.45%), and partial mole (5/14,864, 0.03%, 95% CI 0.01-0.08%). There was a significantly higher risk of gestational trophoblastic neoplasia after complete compared with partial molar pregnancy (RR 4.72, 95% CI 1.81-12.3, P=.002). Among gestational trophoblastic neoplasia cases after normal hCG level following complete mole, 89.6% occurred when the time from evacuation to normalization was 56 days or longer, and 60.7% were diagnosed beyond the commonly recommended 6-month surveillance interval. Sensitivity analyses, including those limiting to studies at low risk of bias, did not significantly affect results. We found an overall incidence of gestational trophoblastic neoplasia of 15.7% for complete mole (1,354/8,611, 95% CI 15.0-16.5%) and 3.95% for partial mole (221/5,593, 95% CI 3.47-4.50%). Gestational trophoblastic neoplasia development after normal hCG level following molar pregnancy is rare. Recommendations for frequency and duration of hCG follow-up can be minimized to lessen burden on patients and informed by the type of molar pregnancy and time interval from uterine evacuation to hCG normalization. PROSPERO, CRD42019116414.

Comparison between vacuum aspiration and forceps plus blunt curettage for the evacuation of complete hydatidiform moles

ObjectiveSuction curettage is recommended for molar evacuation rather than sharp curettage because of its safety. However, the superiority of suction curettage with respect to the incidence of gestational trophoblastic neoplasia (GTN) has not been reported. This study aimed to compare the efficacy and safety of two evacuation procedures, vacuum aspiration and forceps/blunt curettage, for complete hydatidiform moles (CHMs) to determine the differences between them. Materials and methodsPatients with androgenetic CHM determined by multiplex short tandem repeat polymorphism analysis were included in this observational cohort study. Patients underwent evacuation with forceps and blunt curettage (forceps group) before March 2013 and with vacuum aspiration (vacuum group) thereafter. GTN was diagnosed based on the International Federation of Gynecology and Obstetrics 2000 criteria. The incidence of GTN and other clinical parameters were compared. ResultsNinety-two patients were diagnosed with androgenetic CHM. The number of patients in the forceps and vacuum groups was 41 and 51, respectively. The incidence of GTN was 12.2% (5/41) and 13.7% (7/51) in the forceps and vacuum groups, respectively, which was not significantly different (P = 1, Fisher's exact test). No major adverse events, such as uterine perforation and blood transfusion, were noted in either group. The median surgery time was shorter in the vacuum group (16 min) than in the forceps group (25 min) (P = 0.05, Mann–Whitney U test). ConclusionThere were no differences in the incidence of GTN between the forceps and vacuum groups for androgenetic CHM. However, vacuum aspiration could have the advantage of a shorter surgery period. The use of vacuum aspiration for molar pregnancy seems to be safer. Therefore, we recommend suction curettage for the first evacuation of hydatidiform moles.

Predictive Power of Human Chorionic Gonadotropin in Post-Molar Gestational Trophoblastic Neoplasia: A Longitudinal Roc Analysis

Background: The present study aims at identifying an applicable longitudinal marker from the serum human chorionic gonadotropin (hCG) levels during 3 weeks after mole evacuation for predicting the gestational trophoblastic neoplasia (GTN) in patients with partial or complete molar pregnancy. Methods: In this historical cohort study, 201 documents of patients with hydatidiform mole (according to their pathological reports) were investigated. A two-stage shared random effects model was used to describe the relationship between repeated measures of β-hCG (as a longitudinal indicator) and incidence of GTN. A receiver operating characteristic (ROC) curve was used to determine the power of repeated β-hCG values for predicting GTN. Results: Among all patients, 171 cases (85.1%) had spontaneous remission and GTN was detected in 30 cases (14.9%). The modeling approach used in the current study revealed that the repeated measures of β-hCG concentration (in weeks 0, 1, 2, and 3) can correctly classify approximately 86.7% of patients with GTN and 83.0% of patients without GTN. The repeated measures of β-hCG concentration had higher predictive accuracy than cross sectional values of this marker for early detection of GTN. Conclusions: In general, findings of the present study showed that the three-week β-hCG concentration is a powerful marker for predicting GTN in women with molar pregnancy (with AUC of 91.2%). Thus, monitoring the three-week trend of this marker is recommended for early detection of this malignancy in these women.

Clinical Characteristics of Gestational Trophoblastic Neoplasia: A 15-Year Hospital-Based Study.

To analyze the clinical profile of invasive mole (IM) and choriocarcinoma (CCA) in the past 15 years in Western China. A retrospective study was performed on 221 patients with IM and 70 patients with CCA treated in the First Affiliated Hospital of Xi'an Jiaotong University from 1994 to 2009. Patients were assigned into 3 groups by 5 years, and the clinical characteristics were compared among these groups. The incidence was not significantly changed in the past 15 years, whereas the mean age of gestational trophoblastic neoplasia (GTN) was increased significantly, especially for the patients 40 years or older. The symptoms of the patients with GTN did not show significant variation, but the number of patients with CCA without clinical symptoms was increased significantly. The mean values of beta human chorionic gonadotropin in the patients with IM and those with CCA were 459.43 and 661.70 mIu/L, respectively, and the size of uterine lesion was concentrated at 4 cm or less in both the patients with IM and those with CCA, without significant differences. In the past 15 years, the incidence of GTN was still higher than in other countries from 1994 to 2009, and the mean age of patients with GTN was increased significantly, especially for the patients older than 40 years. Furthermore, patients with no clinical manifestations increased significantly, which should be paid more attention in the future works. Serum level of beta human chorionic gonadotropin and pelvic ultrasonography are still 2 important indexes for diagnosing and monitoring condition of GTN.

Influence of oral contraceptives in the development of post-molar trophoblastic neoplasia—A systematic review

Objective. Controversy exists regarding the use of oral contraceptives following hydatidiform mole and possible increased risk of persistent trophoblastic neoplasia. The purpose of this study is to perform a systematic review of the literature to assess the evidence for and against a possible link between oral contraceptive use and the need for chemotherapy after molar evacuation. Methods. We searched the computerized databases MEDLINE, EMBASE, Popline, Web of Sciences, LILACS and the Cochrane Controlled Trials Register, ISI Proceedings, performed a hand search of references and wrote to experts to identify randomized controlled trials and observational studies comparing oral contraceptives with other methods of contraception. Quality assessment included: concealment of allocation; intention to treat analysis; plus attrition bias for trials; confounding factors and selection bias for observational studies. We collected or calculated risk ratios for the incidence of gestational trophoblastic neoplasia and hCG regression time associated with oral contraceptive use. Results. Two randomized controlled trials were included for analysis. The risk ratios for OC use were similar in both studies: 0.69 (0.12–3.98) and 0.71 (0.46–1.10) respectively. No attempt to summarize these results was made because the studies observed different disease stages. In five of the seven observational studies, the risk ratio ranged from 0.57 (CI = 0.14–2.37) to 1.46 (CI = 0.56–3.79). Conclusion. No clear evidence for an association between oral contraceptive use during post-molar follow-up period and the incidence of gestational trophoblastic neoplasia was found. Practitioners should no longer avoid their use because of a supposed effect which we have shown here to be unsupported by evidence in the literature.