Giorgione Veronica, Bergamini Alice, Cioffi Raffaella, Pella Francesca, Rabaiotti Emanuela, Petrone Micaela, Candiani Massimo, Mangili Giorgia
*Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Int J Gynecol Cancer. 2017 Mar;27(3):550-553. doi: 10.1097/IGC.0000000000000903.
Women older than 40 years develop gestational trophoblastic neoplasia (GTN) after a hydatidiform mole (HM) more often than do younger women. Therefore, in elderly women, primary hysterectomy has been advocated as first-line treatment. The aim of the present study was to evaluate whether hysterectomy could reduce the incidence of GTN after a diagnosis of HM.
Seventy-six of 442 patients referred to our unit for an HM between 1994 and 2015 were older than 40 years old. Among these, 12 patients were treated by primary hysterectomy. We compared clinical features, serum human chorionic gonadotrophin (hCG), incidence of GTN, and further treatments in these patients and in those who underwent evacuation and serum hCG monitoring, using univariate and multivariate analyses.
Patients treated by primary hysterectomy all had a diagnosis of a complete or invasive HM, had more hyperemesis than did control subjects (82% vs 37%, P = 0.008), and had an increased uterine volume (100% vs 41%, P = 0.001). Seven of them developed a subsequent GTN, whereas 5 patients achieved complete remission of disease after surgery (58% vs 30%, P = 0.094). All the patients who developed a GTN after surgery showed lower hCG levels than did control subjects (mean, 671.4 [SD, 1178.4] IU/L vs 23,919.4 [SD, 34,284.9] IU/L; P = 0.005), but there were no significant differences in the amount and type of chemotherapy needed to achieve remission.
Primary hysterectomy after 40 years old in women affected by HM does not reduce the incidence of GTN and amount of chemotherapy. Although further studies are needed to confirm these results, a careful hCG monitoring should be recommended in these high-risk patients.
40岁以上女性葡萄胎（HM）后发生妊娠滋养细胞肿瘤（GTN）的几率高于年轻女性。因此，对于老年女性，主张将子宫全切术作为一线治疗方法。本研究旨在评估子宫全切术能否降低HM诊断后GTN的发生率。
1994年至2015年间转诊至我院接受HM治疗的442例患者中，76例年龄超过40岁。其中，12例接受了子宫全切术。我们采用单因素和多因素分析，比较了这些患者以及接受清宫术和血清人绒毛膜促性腺激素（hCG）监测患者的临床特征、血清hCG、GTN发生率及进一步治疗情况。
接受子宫全切术的患者均被诊断为完全性或侵蚀性HM，与对照组相比，恶心呕吐更为严重（82% 对37%，P = 0.008），子宫体积增大（100% 对41%，P = 0.001）。其中7例随后发生GTN，而5例患者术后疾病完全缓解（58% 对30%，P = 0.094）。所有术后发生GTN的患者hCG水平均低于对照组（均值，671.4 [标准差，1178.4] IU/L对23,919.4 [标准差，34,284.9] IU/L；P = 0.005），但达到缓解所需化疗的剂量和类型无显著差异。
40岁以上HM女性患者行子宫全切术并不能降低GTN的发生率和化疗剂量。尽管需要进一步研究来证实这些结果，但建议对这些高危患者进行仔细的hCG监测。
