在首次妊娠期间患有部分性葡萄胎且在妊娠早期被诊断出的女性，发生妊娠滋养细胞肿瘤的风险增加。

Women with a partial mole during their first pregnancy and diagnosed earlier in gestation are at increased risk of developing gestational trophoblastic neoplasia.

机构信息

*Division of Gynecologic Oncology, Brigham and Women's Hospital; †New England Trophoblastic Disease Center, Donald P. Goldstein, MD, Trophoblastic Tumor Registry; ‡Dana Farber Cancer Institute/Harvard Cancer Center; §Harvard Medical School; and ∥Brigham and Women's Hospital/Massachusetts General Hospital Integrated Residency Program in Obstetrics and Gynecology, Boston, MA.

出版信息

Int J Gynecol Cancer. 2014 Jun;24(5):941-5. doi: 10.1097/IGC.0000000000000130.

DOI:10.1097/IGC.0000000000000130

PMID:24819660

Abstract

OBJECTIVE

The aim of this study is to identify factors associated with gestational trophoblastic neoplasia (GTN) after partial molar pregnancy.

METHODS

We retrospectively evaluated clinical data from 111 patients with a partial molar pregnancy between 1995 and 2010.

RESULTS

A total of 111 patients with a partial molar pregnancy were available for analysis. There was no significant difference between patients who did and did not develop GTN with respect to patient age, parity, history of prior molar pregnancy, presenting signs/symptoms, uterine size greater than gestational age, clinical diagnosis, preevacuation sonogram findings, or the preevacuation human chorionic gonadotropin value. Patients who developed GTN had fewer prior pregnancies (median, 2 vs 3; P = 0.02) and were more likely to have had a partial molar pregnancy as their first gestational event (37.1% vs 17.1%; P = 0.03). Among the 35 patients who developed GTN, the median time to diagnosis of GTN was 47 days (range, 25-119 days), and the median human chorionic gonadotropin value at the time of GTN diagnosis was 475 mIU/mL (range, 20-52,630 mIU/mL). All women (100%) who developed GTN had stage I disease, and all patients (100%) had low-risk GTN. All 35 women (100%) were able to achieve remission, and most (85.7%) of these patients received methotrexate as first-line chemotherapy.

CONCLUSIONS

Women with a partial molar pregnancy as their first gestational event and diagnosed earlier in gestation are more likely to develop postmolar GTN.

摘要

目的

本研究旨在确定部分葡萄胎妊娠后发生妊娠滋养细胞肿瘤（GTN）的相关因素。

方法

我们回顾性评估了 1995 年至 2010 年间 111 例部分葡萄胎妊娠患者的临床资料。

结果

共有 111 例部分葡萄胎妊娠患者可供分析。是否发生 GTN 的患者在患者年龄、产次、既往葡萄胎妊娠史、首发症状/体征、子宫大小大于孕周、临床诊断、清宫前超声检查结果或清宫前人绒毛膜促性腺激素值等方面均无显著差异。发生 GTN 的患者既往妊娠次数较少（中位数 2 次比 3 次；P=0.02），且更可能将部分葡萄胎妊娠作为首次妊娠事件（37.1%比 17.1%；P=0.03）。在 35 例发生 GTN 的患者中，GTN 的中位诊断时间为 47 天（范围 25-119 天），GTN 诊断时人绒毛膜促性腺激素值的中位数为 475 mIU/mL（范围 20-52630 mIU/mL）。所有发生 GTN 的患者（100%）均为Ⅰ期疾病，所有患者（100%）均为低危型 GTN。所有 35 例患者（100%）均获得缓解，其中大多数（85.7%）患者接受甲氨蝶呤作为一线化疗。