Braga Antonio, Biscaro Andressa, do Amaral Giordani Jessye Melgarejo, Viggiano Maurício, Elias Kevin M, Berkowitz Ross S, Seckl Michael J
Postgraduate Program in Perinatal Health, Rio de Janeiro Trophoblastic Disease Center, Maternity School, Federal University of Rio de Janeiro and Antonio Pedro University Hospital at Fluminense Federal University, Rio de Janeiro, Brazil; Postgraduate Program in Maternal and Child Health, Fluminense Federal University, Niterói, Brazil.
Postgraduate Program in Maternal and Child Health, Fluminense Federal University, Niterói, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2018 Apr;223:50-55. doi: 10.1016/j.ejogrb.2018.02.001. Epub 2018 Feb 15.
To evaluate whether a human chorionic gonadotropin (hCG) level ≥20,000 IU/L four weeks after uterine evacuation for complete hydatidiform mole (CHM) is an appropriate indicator for initiating chemotherapy for the treatment of gestational trophoblastic neoplasia (GTN).
Historical database review of 1228 women with CHM who received treatment and follow-up between January 2000 and June 2013 at four Brazilian trophoblastic disease centers. The primary outcome measure was the progression from CHM to GTN. The secondary outcomes were the occurrence of uterine perforation, staging of GTN, WHO/FIGO risk score, and treatment (use of single- or multiagent chemotherapy).
An hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM, while occurring in only 6.1% of women, was the most important risk factor for the development of postmolar GTN (adjusted RR = 5.83; p < 0.01; CI: 3.47-9.79), with a sensitivity of 36.8%, a specificity of 98.6%, a positive predictive value of 80%, and a negative predictive value of 91.1%. On the other hand, there were no differences in postmolar GTN stage, prognostic score, or need for multiagent chemotherapy relative to hCG level ≥20,000 IU/L versus <20,000 IU/L.
Although hCG level ≥20,000 IU/L four weeks after uterine evacuation for CHM was very predictive of development of post-molar GTN, delay in treatment until hCG plateau or increase did not affect outcomes, with no uterine perforations or treatment failures.
评估完全性葡萄胎清宫术后四周人绒毛膜促性腺激素（hCG）水平≥20,000 IU/L是否为启动化疗治疗妊娠滋养细胞肿瘤（GTN）的合适指标。
对2000年1月至2013年6月间在巴西四个滋养细胞疾病中心接受治疗和随访的1228例完全性葡萄胎患者的历史数据库进行回顾。主要结局指标是从完全性葡萄胎进展为GTN。次要结局包括子宫穿孔的发生、GTN的分期、世界卫生组织/国际妇产科联盟（WHO/FIGO）风险评分以及治疗情况（单药或多药化疗的使用）。
完全性葡萄胎清宫术后四周hCG水平≥20,000 IU/L，虽仅在6.1%的女性中出现，但却是葡萄胎后GTN发生的最重要危险因素（校正相对危险度=5.83；p<0.01；可信区间：3.47 - 9.79），其敏感度为36.8%，特异度为98.6%，阳性预测值为80%，阴性预测值为91.1%。另一方面，相对于hCG水平≥20,000 IU/L与<20,000 IU/L，葡萄胎后GTN分期、预后评分或多药化疗需求并无差异。
尽管完全性葡萄胎清宫术后四周hCG水平≥20,000 IU/L对葡萄胎后GTN的发生具有很强的预测性，但延迟治疗直至hCG达到平台期或升高并未影响结局，未出现子宫穿孔或治疗失败情况。
