Gynecologic and Obstetric Clinic, Aristide Le Dantec Teaching Hospital, Cheikh Anta Diop University, Dakar, Senegal.
BJOG. 2014 Oct;121(11):1415-9. doi: 10.1111/1471-0528.12742. Epub 2014 Mar 28.
To determine the risk of recurrent trophoblastic disease after normalisation of human chorionic gonadotrophin (hCG) levels in women with hydatidiform mole.
A retrospective review of data from a national gestational trophoblastic disease centre.
The Trophoblastic Disease Unit, Dakar, Senegal.
Women with pregnancies affected by hydatidiform mole registered between 2006 and 2012.
The women were followed up in accordance with the hospital protocol 'Score de Dakar'. For women who progressed to gestational trophoblastic neoplasia (GTN) the time to onset of GTN, treatment and evolution were evaluated. The rate of evolution to GTN after normalisation of hCG was determined.
Rate of occurrence of GTN after chemotherapy for hydatidiform mole.
Five hundred and thirty-one women were diagnosed to have molar pregnancies. According to the hospital's protocol, 107 (20.2%) of these had chemotherapy and 224 (42.2%) had prophylactic chemotherapy. Five hundred and thirteen women (96.4%; 95% confidence interval [95% CI] 95.05-98.14%) achieved remission. Eighteen women (3.4%; 95% CI 1.86-4.94%) developed GTN (11 before remission and seven after remission). Seven women out of the 18 developed GTN after hCG normalisation (1.3%). Five of these seven were diagnosed beyond the recommended period of follow up. The mean interval to diagnosis of GTN was 18.7 months. These seven women underwent combination chemotherapy: five achieved complete remission whereas two died from GTN.
Cytotoxic therapy for hydatidiform mole does not prevent GTN, it delays its diagnosis and promotes GTN after normalisation of hCG.
确定人绒毛膜促性腺激素（hCG）水平正常化后患有葡萄胎的女性发生复发性滋养细胞疾病的风险。
对塞内加尔达喀尔滋养细胞疾病中心的全国性妊娠滋养细胞疾病中心数据进行回顾性分析。
塞内加尔达喀尔滋养细胞疾病科。
2006 年至 2012 年间患有葡萄胎的妊娠患者。
根据医院的“达喀尔评分”方案对这些女性进行随访。对于进展为妊娠滋养细胞肿瘤（GTN）的女性，评估 GTN 的发病时间、治疗和进展情况。确定 hCG 正常化后发生 GTN 的发生率。
葡萄胎化疗后发生 GTN 的发生率。
531 名女性被诊断为葡萄胎妊娠。根据医院的方案，其中 107 例（20.2%）接受了化疗，224 例（42.2%）接受了预防性化疗。513 名女性（96.4%；95%置信区间[95%CI]95.05-98.14%）达到缓解。18 名女性（3.4%；95%CI 1.86-4.94%）发生 GTN（缓解前 11 例，缓解后 7 例）。在 18 名发生 GTN 的女性中，有 7 名在 hCG 正常化后发生（1.3%）。这 7 名中有 5 名在推荐的随访期过后被诊断出来。诊断为 GTN 的平均间隔时间为 18.7 个月。这 7 名女性接受了联合化疗：5 名完全缓解，而 2 名死于 GTN。
葡萄胎的细胞毒性治疗并不能预防 GTN，它会延迟其诊断，并促进 hCG 正常化后 GTN 的发生。
