Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Int J Gynecol Cancer. 2018 Nov;28(9):1772-1780. doi: 10.1097/IGC.0000000000001374.
The aim of this study was to evaluate the incidence and risk factors of gestational trophoblastic neoplasia (GTN) from hydatidiform moles (HMs) cytogenetically diagnosed in a prospective cohort setting.
The prospective observational cohort study included cases of cytogenetically defined molar pregnancies, which were diagnosed by a multiplex short tandem repeat polymorphism analysis. Cases were classified as androgenetic complete HMs (CHMs), diandric monogynic triploid partial HMs (PHMs), or biparental abortion. Gestational trophoblastic neoplasia was diagnosed according to the International Federation of Gynecology and Obstetrics 2000 criteria. Incidences for each category, that is, CHM, PHMs, and biparental abortion, were calculated. Clinical variables (age, partner age, gravidity, parity, height, weight, BMI, and gestational age) and laboratory data (serum human chorionic gonadotropin [hCG], white blood cell count, hemoglobin, and platelet count) were compared between spontaneous remission cases and GTN cases in androgenetic CHMs.
Among 401 cases, 380 were classified as follows: 232 androgenetic CHMs, 60 diandric monogynic PHMs, and 88 biparental abortions. A total of 35 cases (15.1%) of CHMs, but only 1 case of PHM (1.7%) and no biparental abortions, exhibited progression to GTN. The hCG value before evacuation was significantly higher in GTN cases than in spontaneous remission cases (P = 0.001, Kruskal-Wallis test). Patient age was also significantly higher in GTN cases than in spontaneous remission cases (P = 0.002, Student t test).
Under the cohort cytogenetic diagnosis setting, the traditional risk factors for GTN after molar pregnancy, hCG value before evacuation and age, were confirmed in androgenetic CHMs. The risk of GTN was lower for PHMs than for CHMs. However, 1 patient with cytogenetic PHMs developed into GTN.
本研究旨在评估在前瞻性队列研究中，通过细胞遗传学诊断为葡萄胎（HM）的滋养细胞肿瘤（GTN）的发生率和危险因素。
这项前瞻性观察性队列研究纳入了通过多重短串联重复多态性分析诊断为细胞遗传学定义的葡萄胎病例。病例被分为完全性雄激素性 HM（CHM）、二倍体单卵三体型部分 HM（PHM）或双亲性流产。根据国际妇产科联合会 2000 标准诊断 GTN。计算每种类型（CHM、PHM 和双亲性流产）的发生率。比较 CHM 自发缓解病例和 GTN 病例的临床变量（年龄、伴侣年龄、孕次、产次、身高、体重、BMI 和孕龄）和实验室数据（血清人绒毛膜促性腺激素[hCG]、白细胞计数、血红蛋白和血小板计数）。
在 401 例病例中，380 例分类如下：232 例完全性雄激素性 CHM、60 例二倍体单卵三体型 PHM 和 88 例双亲性流产。共有 35 例（15.1%）CHM 但仅有 1 例 PHM（1.7%）和无双亲性流产进展为 GTN。GTN 病例的 hCG 值在清宫前明显高于自发缓解病例（P = 0.001，Kruskal-Wallis 检验）。GTN 病例的年龄也明显高于自发缓解病例（P = 0.002，Student t 检验）。
在队列细胞遗传学诊断背景下，传统的 HM 后 GTN 危险因素，包括清宫前 hCG 值和年龄，在雄激素性 CHM 中得到了证实。PHM 的 GTN 风险低于 CHM。然而，1 例细胞遗传学 PHM 发展为 GTN。
