Braga Antonio, Andrade Taiane, do Carmo Borges de Souza Maria, Campos Vanessa, Freitas Fernanda, Maestá Izildinha, Sun Sue Yazaki, Pedrotti Luana Giongo, Bessel Marina, Junior Joffre Amim, Filho Jorge Rezende, Elias Kevin M, Horowitz Neil S, Berkowitz Ross S
Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University), Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil; Postgraduate Program in Applied Health Sciences, Vassouras University, Rio de Janeiro, RJ, Brazil; National Academy of Medicine, Young Leadership Physicians Program, Rio de Janeiro, RJ, Brazil.
Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University), Postgraduate Program in Perinatal Health, Faculty of Medicine, Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.
Gynecol Oncol. 2023 Mar;170:179-185. doi: 10.1016/j.ygyno.2023.01.016. Epub 2023 Jan 25.
To describe the natural history of hydatidiform mole (HM) after intracytoplasmic sperm injection (ICSI), emphasizing the clinical and oncological outcomes, as compared to patients who had HM after spontaneous conception (SC).
Retrospective historical cohort study of patients with HM followed at the Rio de Janeiro Federal University, from January 1st 2000-December 31st 2020.
Comparing singleton HM after SC to those following ICSI there were differences in terms of maternal age (24 vs 34 years, p < 0.01), gestational age at diagnosis (10 vs 7 weeks, p < 0.01), preevacuation human chorionic gonadotropin levels (200,000 vs 99,000 IU/L, p < 0.01), occurrence of genital bleeding (60.5 vs 26.9%, p < 0.01) and hyperemesis (23 vs 3.9%, p = 0.02) at presentation, and time to remission (12 vs 5 weeks, p < 0.01), respectively. There were no differences observed in the cases of twin mole, regardless of the form of fertilization that gave rise to HM, except molar histology with greater occurrence of partial hydatidiform mole (10.7 vs 40.0%, p = 0.01) following ICSI. Univariate logistic regression for occurrence of postmolar GTN after ICSI identified no predictor variable for this outcome. However, after adjusting for maternal age and complete hydatidiform mole histology, multivariable logistic regression showed the risk of GTN with HM after ICSI had an adjusted odds ratio of 0.22 (95%CI:0.05-0.93, p = 0.04), suggesting a possible protective effect when compared to HM after SC.
Singleton HM after ICSI are diagnosed earlier in gestation, present with fewer medical complications, and may be less likely to develop GTN when compared with HM after SC.
描述卵胞浆内单精子注射（ICSI）后葡萄胎（HM）的自然病史，强调与自然受孕（SC）后发生HM的患者相比，其临床和肿瘤学结局。
对2000年1月1日至2020年12月31日在里约热内卢联邦大学随访的HM患者进行回顾性历史队列研究。
将SC后的单胎HM与ICSI后的单胎HM进行比较，在以下方面存在差异：产妇年龄（24岁对34岁，p<0.01）、诊断时的孕周（10周对7周，p<0.01）、清宫前血清人绒毛膜促性腺激素水平（200,000对99,000 IU/L，p<0.01）、就诊时发生生殖器出血的情况（60.5%对26.9%，p<0.01）和妊娠剧吐（23%对3.9%，p=0.02），以及缓解时间（12周对5周，p<0.01）。在双胎葡萄胎病例中，无论导致HM的受精形式如何，均未观察到差异，但ICSI后部分性葡萄胎的发生率更高（10.7%对40.0%，p=0.01）。对ICSI后发生葡萄胎后妊娠滋养细胞肿瘤（GTN）进行单因素逻辑回归分析，未发现该结局的预测变量。然而，在对产妇年龄和完全性葡萄胎组织学进行校正后，多因素逻辑回归显示，ICSI后HM发生GTN的风险经校正后的比值比为0.22（95%CI：0.05-0.93，p=0.04），表明与SC后HM相比可能具有保护作用。
与SC后HM相比，ICSI后的单胎HM在妊娠早期被诊断出来，医学并发症较少，发生GTN的可能性也较小。
