Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Hum Reprod. 2010 May;25(5):1183-91. doi: 10.1093/humrep/deq052. Epub 2010 Mar 5.
Complete hydatidiform mole (CHM) is a high-risk pregnancy for gestational trophoblastic neoplasia (GTN). Patients with CHM have a 10-30% chance of trophoblastic sequelae. CHM includes androgenic homozygous (monospermic) and androgenic heterozygous (dispermic) moles. It is controversial whether the risk of GTN is higher with heterozygous than with homozygous CHM. A prospective cohort study was conducted to assess risk of GTN in homozygous and heterozygous CHM using short tandem repeat (STR) polymorphisms, and a meta-analysis of previous reports.
Twenty-eight consecutive molar pregnancies were evacuated and followed by regular hCG measurements to detect GTN. Persistent GTN was diagnosed according to the International Federation of Gynecology and Obstetrics 2000 system. Cytogenesis of the mole was determined by STR polymorphisms of molar tissue and parental blood. A meta-analysis of the GTN rate from previous reports was conducted using Mantel-Haenszel methods.
Of 28 molar pregnancies, 24 were homozygous and three were heterozygous CHM. The remaining mole was diandric triploidy (a partial hydatidiform mole). Of the 24 homozygous CHMs, six (25%) cases developed GTN and received chemotherapy. Meanwhile, all three cases (100%) of heterozygous mole developed GTN and needed chemotherapy. The GTN risk was higher in heterozygous (P = 0.029, Fisher's exact test) than homozygous moles. A systematic review revealed only five previous reports (with more than 15 cytogenetically diagnosed cases), and the pooled relative risk of persistent GTN for heterozygous mole was not significant (odds ratio, 2.0; 95% confidence interval, 0.98-4.07).
Heterozygous CHM had a higher risk for GTN than homozygous CHM.
完全性葡萄胎（CHM）是一种发生妊娠滋养细胞肿瘤（GTN）风险较高的妊娠。患有 CHM 的患者有 10-30%发生滋养细胞后遗症的风险。CHM 包括雄激素同合（单倍体）和雄激素异合（双倍体）葡萄胎。关于异合性 CHM 发生 GTN 的风险是否高于同合性 CHM 存在争议。本前瞻性队列研究通过短串联重复（STR）多态性评估同合性和异合性 CHM 发生 GTN 的风险，并对之前的报告进行荟萃分析。
连续 28 例葡萄胎妊娠排空后，通过定期 hCG 测量来检测 GTN。根据国际妇产科联合会 2000 年的系统诊断持续性 GTN。通过 STR 多态性分析葡萄胎组织和父母血液来确定葡萄胎的细胞遗传学。采用 Mantel-Haenszel 方法对之前报告中的 GTN 发生率进行荟萃分析。
28 例葡萄胎中，24 例为同合性 CHM，3 例为异合性 CHM。其余的葡萄胎为二倍体三倍体（部分葡萄胎）。24 例同合性 CHM 中，有 6 例（25%）发生 GTN 并接受化疗。同时，3 例（100%）异合性葡萄胎均发生 GTN，需要化疗。异合性葡萄胎的 GTN 风险更高（P=0.029，Fisher 精确检验）。系统评价仅发现之前的 5 项报告（超过 15 例经细胞遗传学诊断的病例），异合性葡萄胎持续性 GTN 的汇总相对风险无统计学意义（比值比，2.0；95%置信区间，0.98-4.07）。
异合性 CHM 发生 GTN 的风险高于同合性 CHM。
