Cole Laurence A, Butler Stephen A, Khanlian Sarah A, Giddings Almareena, Muller Carolyn Y, Seckl Michael J, Kohorn Ernest I
USA hCG Reference Service, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.
Gynecol Oncol. 2006 Aug;102(2):151-9. doi: 10.1016/j.ygyno.2005.12.045. Epub 2006 May 2.
To determine whether circulating hyperglycosylated human chorionic gonadotropin (hCG-H), a promoter of choriocarcinoma growth and tumorigenesis, is a reliable marker of active gestational trophoblastic neoplasia (GTN) or choriocarcinoma, and whether hCG-H can consistently discriminate quiescent gestational trophoblastic disease (GTD) from neoplasia.
Patients were those referred to the USA hCG Reference Service for consultation. These included a total of 82 women with GTN, including 30 with histologic choriocarcinoma. They were compared with 26 patients with resolving hydatidiform mole and 69 with quiescent GTD (persistent positive low value of real hCG but no clinical evidence of disease). All were tested for total hCG and hCG-H. hCG-H was calculated as the percentage of total hCG (hCG-H(%)).
We compared the utility of total hCG and hCG-H(%) in detecting active GTN and quiescent GTD. There was no significant difference when measuring total hCG (includes regular and hyperglycosylated hCG), between women with quiescent GTD and self-resolving hydatidiform mole compared to choriocarcinoma/GTN cases (P > 0.05 and P > 0.05). In contrast, hCG-H(%) was significantly higher in choriocarcinoma/GTN cases (P < 0.000001, and P < 0.000001). The usefulness of hCG and hCG-H(%) testing was assessed for discriminating between the 69 quiescent GTD cases, which required no therapy, and choriocarcinoma/GTN which need treatment. While hCG would detect 62% and 24% of malignancies at a 5% false positive rate, hCG-H(%) would detect 100% and 84% of malignancies at this same false positive rate. Follow-up data were received and repeat consultations were performed in 23 cases in which active disease was subsequently demonstrated. In 12 of 23 cases, hCG-H(%) results were able to first identify active disease 0.5 to 11 months prior to rapidly rising hCG or detection of clinically active neoplasia. In the remaining 11 cases, hCG-H(%) active disease appeared at the same time as rising hCG or demonstrable clinical tumor.
hCG-H(%) appears to reliably identify active trophoblastic malignancy. It is a 100% sensitive marker for discriminating quiescent GTD from active GTN/choriocarcinoma. It is also a marker for the early detection of new or recurrent GTN/choriocarcinoma. The data presented appear sufficient to encourage the adoption of hCG-H as a tumor marker in trophoblastic disease. Further studies are now urgently required to confirm and extend our findings.
确定循环中的高糖基化人绒毛膜促性腺激素（hCG-H），一种绒毛膜癌生长和肿瘤发生的促进因子，是否是活跃性妊娠滋养细胞肿瘤（GTN）或绒毛膜癌的可靠标志物，以及hCG-H是否能持续区分静止性妊娠滋养细胞疾病（GTD）和肿瘤形成。
患者为转诊至美国hCG参考服务中心进行咨询的人群。其中共有82例GTN女性患者，包括30例组织学绒毛膜癌患者。将她们与26例葡萄胎消退患者以及69例静止性GTD患者（实际hCG持续呈低阳性但无疾病临床证据）进行比较。所有患者均检测了总hCG和hCG-H。hCG-H以总hCG的百分比计算（hCG-H(%)）。
我们比较了总hCG和hCG-H(%)在检测活跃性GTN和静止性GTD中的效用。在测量总hCG（包括常规和高糖基化hCG）时，静止性GTD女性与葡萄胎自行消退患者相比，与绒毛膜癌/GTN病例之间无显著差异（P>0.05和P>0.05）。相比之下，绒毛膜癌/GTN病例中的hCG-H(%)显著更高（P<0.000001，P<0.000001）。评估了hCG和hCG-H(%)检测在区分69例无需治疗的静止性GTD病例和需要治疗的绒毛膜癌/GTN病例中的效用。在5%的假阳性率下，hCG可检测出62%和24%的恶性肿瘤，而hCG-H(%)在相同假阳性率下可检测出100%和84%的恶性肿瘤。收到了随访数据，并对23例随后证实有活动性疾病的病例进行了再次咨询。在23例中的12例中，hCG-H(%)结果能够在hCG迅速升高或检测到临床活动性肿瘤之前0.5至11个月首次识别出活动性疾病。在其余11例中，hCG-H(%)活动性疾病与hCG升高或可证实的临床肿瘤同时出现。
hCG-H(%)似乎能可靠地识别活跃性滋养细胞恶性肿瘤。它是区分静止性GTD与活跃性GTN/绒毛膜癌的100%敏感标志物。它也是早期检测新的或复发性GTN/绒毛膜癌的标志物。所呈现的数据似乎足以鼓励将hCG-H用作滋养细胞疾病的肿瘤标志物。现在迫切需要进一步研究来证实和扩展我们的发现。
