Cole Laurence A, Khanlian Sarah A, Giddings Almareena, Butler Stephen A, Muller Carolyn Y, Hammond Charles, Kohorn Ernest
USA hCG Reference Service, Department of Obstetrics and Gynecology, MSC10 5580 1, University of New Mexico, Albuquerque, NM 87131-0001, USA.
Gynecol Oncol. 2006 Aug;102(2):165-72. doi: 10.1016/j.ygyno.2005.12.048. Epub 2006 May 2.
A high proportion of women with persistent low levels of hCG, in the absence of pregnancy or any evidence of tumor, have received chemotherapy and hysterectomy for assumed malignancy. Such chemotherapy and surgery were ineffective and unwarranted. This study identifies the causes of persistent low level of hCG and provides guidelines for the management of these patients, preventing unnecessary treatment in the future.
The USA hCG Reference Service has consulted on 170 women with low levels of hCG persisting for 3 months or longer. Serum total hCG was measured in the Diagnostic Products Corporation (DPC) Immulite assay and hyperglycosylated hCG in the Nichols Advantage test.
Among these 170 patients, the average persistent hCG result was 102 +/- 152 mIU/ml, with a range of 6.1-900 mIU/ml. Thirteen (7.6%) of the 170 patients had true malignancy, 5 had placental site trophoblastic tumor, 3 had other gestational trophoblastic neoplasms (GTN), and 5 had non-trophoblastic malignancies. The remaining 157 patients had false-positive hCG, quiescent gestational trophoblastic disease (quiescent GTD), or pituitary hCG (hCG of pituitary origin). Of 71 patients with false-positive hCG, 47 patients received chemotherapy and 9 had surgery that had no effect on the level of hCG. Five of these patients with false-positive hCG were being monitored for hydatidiform mole or GTN. The majority of these cases were first investigated following an incidental pregnancy test. Of 69 patients who had quiescent GTD, 41 received chemotherapy and 9 underwent hysterectomy. All these therapies were unnecessary and ineffective. While 21 patients with quiescent GTD followed incidental pregnancy tests, the majority were discovered while monitoring patients after treatment for hydatidiform mole or GTN/choriocarcinoma (n = 48). Seventeen cases of pituitary hCG were found among those women who were peri- or post-menopause. Two patients also received chemotherapy for assumed malignancy which was not present.
Clinicians frequently assume that an elevated hCG implies that a patient is pregnant or has GTD or recurrent GTN, even when apart from the pregnancy test, no clinical evidence was found to support such a diagnosis. In most of these cases of persistent low hCG etiologies, all therapies were found unnecessary and ineffective. Guidelines are proposed for managing these patients. It is essential to demonstrate a malignancy clinically and with readily available biochemical tests before initiating therapy. This applies whether the patient is identified by an incidental pregnancy test or is actively being monitored for gestational trophoblastic disease.
在未怀孕或无任何肿瘤证据的情况下，有很大一部分人绒毛膜促性腺激素（hCG）水平持续较低的女性因被假定为恶性肿瘤而接受了化疗和子宫切除术。这种化疗和手术既无效又无必要。本研究确定了hCG水平持续较低的原因，并为这些患者的管理提供指导方针，以防止未来进行不必要的治疗。
美国hCG参考服务中心已为170名hCG水平持续较低达3个月或更长时间的女性提供咨询。采用诊断产品公司（DPC）免疫发光法测定血清总hCG，采用尼科尔斯优势检测法测定高糖基化hCG。
在这170例患者中，hCG持续检测结果的平均值为102±152 mIU/ml，范围为6.1 - 900 mIU/ml。170例患者中有13例（7.6%）患有真正的恶性肿瘤，5例患有胎盘部位滋养细胞肿瘤，3例患有其他妊娠滋养细胞肿瘤（GTN），5例患有非滋养细胞恶性肿瘤。其余157例患者的hCG为假阳性、静止性妊娠滋养细胞疾病（静止性GTD）或垂体来源的hCG（垂体hCG）。在71例hCG假阳性的患者中，47例接受了化疗，9例接受了对hCG水平无影响的手术。这些hCG假阳性患者中有5例正在接受葡萄胎或GTN的监测。这些病例大多数是在偶然的妊娠试验后首次进行检查的。在69例患有静止性GTD的患者中，41例接受了化疗，9例接受了子宫切除术。所有这些治疗都是不必要且无效的。虽然69例静止性GTD患者中有21例是在偶然的妊娠试验后被发现的，但大多数是在对葡萄胎或GTN/绒毛膜癌进行治疗后监测患者时被发现（n = 48）。在围绝经期或绝经后的女性中发现了17例垂体hCG病例。2例患者也因不存在的假定恶性肿瘤接受了化疗。
临床医生常常认为hCG升高意味着患者怀孕或患有GTD或复发性GTN，即使除了妊娠试验外，没有临床证据支持这种诊断。在大多数这些hCG持续较低病因的病例中，所有治疗均被发现是不必要且无效的。提出了管理这些患者的指导方针。在开始治疗前，必须通过临床和易于获得的生化检测来证实存在恶性肿瘤。无论患者是通过偶然的妊娠试验被发现，还是正在接受妊娠滋养细胞疾病的积极监测，这一点都适用。
