Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Int J Gynecol Cancer. 2013 Jul;23(6):1150-6. doi: 10.1097/IGC.0b013e31829703ea.
Currently, human chorionic gonadotropin (hCG) follow-up after evacuation of hydatidiform moles is essential to identify patients requiring chemotherapeutic treatment for gestational trophoblastic neoplasia (GTN). We propose a model based on linear regression of postevacuation serum hCG concentrations for the prediction of GTN.
One hundred thirteen patients with at least 3 serum samples from days 7 to 28 after evacuation were selected from the Dutch Central Registry for Hydatidiform Moles (1994-2009). The slopes of the linear regression lines of the first 3 log-transformed serum hCG and free β-hCG values were calculated. Receiver operating characteristic curves were constructed to calculate areas under curve (AUCs).
The slope of the hCG regression line showed an AUC of 0.906 (95% confidence interval, 0.845-0.967). Gestational trophoblastic neoplasia could be predicted in 52% of patients with GTN at 97.5% specificity (cutoff, -0.020). Twenty-one percent of patients with GTN could be predicted before diagnosis according to the International Federation of Gynecology and Obstetrics 2000 criteria. The slope of free β-hCG showed an AUC of 0.844 (95% confidence interval, 0.752-0.935), 69% sensitivity at 97.5% specificity, and 38% of patients with GTN could be predicted before diagnosis according to the International Federation of Gynecology and Obstetrics criteria.
The slope of the linear regression line of hCG proved to be a good test to discriminate between patients who will achieve spontaneous disease remission and patients developing GTN. The slope of free β-hCG seems to be a better predictor for GTN than the slope of hCG. Although this model needs further validation for different assays, it seems a promising way to predict the more aggressive cases of GTN.
目前，在清除葡萄胎后监测人绒毛膜促性腺激素（hCG）对于诊断妊娠滋养细胞肿瘤（GTN）患者是否需要化疗至关重要。我们提出了一种基于清宫后血清 hCG 浓度线性回归的模型，用于预测 GTN。
从荷兰中央葡萄胎登记处（1994-2009 年）中选择了 113 例至少有 3 份清宫后 7-28 天血清样本的患者。计算了前 3 个对数转换血清 hCG 和游离β-hCG 值的线性回归线斜率。构建了受试者工作特征曲线以计算曲线下面积（AUC）。
hCG 回归线斜率的 AUC 为 0.906（95%置信区间，0.845-0.967）。以 97.5%的特异性（截断值，-0.020）可以预测 52%的 GTN 患者。根据国际妇产科联合会 2000 年的标准，21%的 GTN 患者可以在诊断前预测到。游离β-hCG 的斜率的 AUC 为 0.844（95%置信区间，0.752-0.935），特异性为 97.5%时的敏感性为 69%，根据国际妇产科联合会的标准，38%的 GTN 患者可以在诊断前预测到。
hCG 线性回归线的斜率被证明是区分将自发疾病缓解的患者和发生 GTN 的患者的良好检测方法。游离β-hCG 的斜率似乎比 hCG 的斜率更能预测 GTN。虽然该模型需要针对不同的检测方法进一步验证，但它似乎是预测更具侵袭性 GTN 病例的一种有前途的方法。
