Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Obstet Gynecol. 2020 Jan;135(1):12-23. doi: 10.1097/AOG.0000000000003566.
To estimate the incidence of gestational trophoblastic neoplasia following complete and partial molar pregnancy after reaching normal human chorionic gonadotropin (hCG) levels to guide evidence-based follow-up recommendations.
MEDLINE, EMBASE, Web of Science, POPLINE, Cochrane, and ClinicalTrials.gov were searched from inception to November 2018, using the intersection of "gestational trophoblastic disease," "molar pregnancy," and "human chorionic gonadotropin" themes.
Search results were screened to identify cohort studies of molar pregnancy reporting gestational trophoblastic neoplasia development, with at least 6 months of intended normal hCG follow-up.
TABULATION, INTEGRATION, AND RESULTS: Two reviewers independently identified articles for inclusion. Data were extracted using a standardized form. For meta-analysis, cumulative incidence of gestational trophoblastic neoplasia, with CIs by the Agresti-Coull method, and pooled risk ratios (RRs) comparing complete and partial mole were calculated. Among the 19 eligible studies that reported adequate data for inclusion in the primary meta-analysis, we found low incidence of gestational trophoblastic neoplasia after normal hCG level following both complete mole (64/18,357, 0.35%, 95% CI 0.27-0.45%), and partial mole (5/14,864, 0.03%, 95% CI 0.01-0.08%). There was a significantly higher risk of gestational trophoblastic neoplasia after complete compared with partial molar pregnancy (RR 4.72, 95% CI 1.81-12.3, P=.002). Among gestational trophoblastic neoplasia cases after normal hCG level following complete mole, 89.6% occurred when the time from evacuation to normalization was 56 days or longer, and 60.7% were diagnosed beyond the commonly recommended 6-month surveillance interval. Sensitivity analyses, including those limiting to studies at low risk of bias, did not significantly affect results. We found an overall incidence of gestational trophoblastic neoplasia of 15.7% for complete mole (1,354/8,611, 95% CI 15.0-16.5%) and 3.95% for partial mole (221/5,593, 95% CI 3.47-4.50%).
Gestational trophoblastic neoplasia development after normal hCG level following molar pregnancy is rare. Recommendations for frequency and duration of hCG follow-up can be minimized to lessen burden on patients and informed by the type of molar pregnancy and time interval from uterine evacuation to hCG normalization.
PROSPERO, CRD42019116414.
估计达到正常人绒毛膜促性腺激素（hCG）水平后完全性和部分性葡萄胎妊娠绒毛膜滋养细胞肿瘤的发生率，以指导基于证据的随访建议。
从建库到 2018 年 11 月，使用“妊娠滋养细胞疾病”、“葡萄胎”和“人绒毛膜促性腺激素”主题的交集，在 MEDLINE、EMBASE、Web of Science、POPLINE、Cochrane 和 ClinicalTrials.gov 中进行了检索。
筛选搜索结果以确定至少有 6 个月的预期正常 hCG 随访的葡萄胎妊娠报告绒毛膜滋养细胞肿瘤发展的队列研究。
列表、综合和结果：两名审查员独立确定纳入的文章。使用标准化表格提取数据。对于荟萃分析，使用 Agresti-Coull 方法计算绒毛膜滋养细胞肿瘤的累积发生率，置信区间（CI），并计算完全性和部分性葡萄胎的合并风险比（RR）。在 19 项符合主要荟萃分析纳入标准的合格研究中，我们发现正常 hCG 水平后完全性葡萄胎（64/18,357，0.35%，95%CI 0.27-0.45%）和部分性葡萄胎（5/14,864，0.03%，95%CI 0.01-0.08%）绒毛膜滋养细胞肿瘤的发生率较低。完全性葡萄胎妊娠后 hCG 水平正常的绒毛膜滋养细胞肿瘤的风险明显高于部分性葡萄胎（RR 4.72，95%CI 1.81-12.3，P=.002）。在完全性葡萄胎妊娠后 hCG 水平正常的绒毛膜滋养细胞肿瘤病例中，89.6%发生在从清宫到正常化的时间为 56 天或更长时间，60.7%在通常推荐的 6 个月监测间隔之外诊断。敏感性分析，包括那些将研究限制在低偏倚风险的分析，并没有显著影响结果。我们发现完全性葡萄胎的绒毛膜滋养细胞肿瘤总发生率为 15.7%（1,354/8,611，95%CI 15.0-16.5%），部分性葡萄胎为 3.95%（221/5,593，95%CI 3.47-4.50%）。
葡萄胎妊娠后 hCG 水平正常后绒毛膜滋养细胞肿瘤的发展很少见。可以通过减少 hCG 随访的频率和持续时间来最大限度地减少对患者的负担，并根据葡萄胎的类型和从子宫排空到 hCG 正常化的时间间隔来指导。
PROSPERO，CRD42019116414。
