Department of Healthcare Administrationy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2020 May;82(2):183-191. doi: 10.18999/nagjms.82.2.183.
The management of hydatidiform mole (HM) and the incidence of post-molar gestational trophoblastic neoplasia (GTN) in Vietnam has not been reported to date. This study aimed to study the incidence of HM and post-molar GTN and identify factors associated with post-molar GTN at a tertiary hospital in Vietnam. Five hundred and eighty-four patients who were treated for HM at Tu Du Hospital between January and December 2010 were included in this study. The mean age and gestational age at the first evacuation were 28.8 years old and 11.0 weeks, respectively. After the initial evacuation and pathological examination, 87 patients who were older than 40 or did not wish to have children underwent a hysterectomy, while the others underwent second curettage. All 472 patients who had human chorionic gonadotropin (hCG) ≥ 100,000 IU/L before treatment received one cycle of methotrexate with folinic acid as prophylactic chemotherapy. The incidence of HM was 11.1 per 1,000 deliveries; 47 patients (8.0%) developed post-molar GTN. Gestational week, hCG level at one week after the first evacuation, and pathological remnants were significantly associated with the development of post-molar GTN. The results of this study suggest that prophylactic chemotherapy and hysterectomy may be useful for high-risk HM patients to reduce post-molar GTN in settings in which the risk of post-molar GTN and loss to follow-up after HM are greater and hCG measurements and appropriate GTN treatments are unavailable. However, future studies on the long-term outcomes and side effects of prophylactic therapies on HM are required.
迄今为止，尚未有关于越南葡萄胎（HM）的管理和绒癌（GTN）发病情况的报道。本研究旨在研究越南一家三级医院 HM 和绒癌的发病情况，并确定与 HM 后绒癌相关的因素。本研究纳入了 2010 年 1 月至 12 月期间在图都医院因 HM 接受治疗的 584 例患者。首次排空时的平均年龄和妊娠龄分别为 28.8 岁和 11.0 周。初始排空和病理检查后，87 例年龄大于 40 岁或不希望生育的患者接受了子宫切除术，而其余患者接受了二次刮宫。所有 472 例 hCG≥100,000IU/L 的患者在治疗前接受了一个周期的甲氨蝶呤联合亚叶酸钙作为预防性化疗。HM 的发病率为每 1000 例分娩 11.1 例；47 例（8.0%）发生 HM 后绒癌。妊娠周数、首次排空后一周的 hCG 水平和病理残留与 HM 后绒癌的发生显著相关。本研究结果表明，预防性化疗和子宫切除术可能对高危 HM 患者有用，可降低 HM 后绒癌的发病率，尤其是在 HM 后绒癌风险较高、随访丢失风险较大且无法进行 hCG 测量和适当 GTN 治疗的情况下。然而，需要对 HM 的预防性治疗的长期结局和副作用进行进一步研究。
