Evaluation of β-hCG regression after evacuation of molar pregnancy as a predictive factor for malignant GTN
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20243587Keywords:
Hydatidiform mole, Post evacuation, Serum β-hCG, Gestational trophoblastic neoplasiaAbstract
Background: Gestational trophoblastic disease (GTD) is a group of disorders identified by abnormal proliferation of trophoblastic tissue. The general term GTN is used to describe a wide range of trophoblastic diseases including invasive mole, choriocarcinoma, epithelioid trophoblastic tumor, and placental site trophoblastic tumor. The persistence of GTN post-molar pregnancy can be efficiently detected with serial measures of the β subunit of hCG, or β-hCG. Therefore, this study aimed to evaluate the β-hCG regression after evacuation of molar pregnancy as a predictive factor for malignant GTN.
Methods: This was a prospective analytical study conducted in the Gynaecological Oncology Unit and Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh during the period from January 2022 to December 2022. In our study, we included 50 patients with molar pregnancies attending the Gynaecological Oncology Unit and Department of Obstetrics & Gynecology of DMCH.
Result: The mean age of participants was 23.5 years. The GTN was diagnosed among 24% of patients. In 2nd week, the mean β-hCG was found 91027.50±24430.53 miU/ml in the persistent GTN group and 19339.68±13978.59 miU/ml in the remission group. The mean Β-hCG significantly decreased to 64399.33±23404.81 and 4.47±2.57miU/ml in the persistent GTN and remission group respectively in the 15th week (p<0.05).
Conclusion: This study found that serum β-hCG levels in the 2nd, 3rd, and 4th weeks following molar evacuation can predict over 24% of patients who developed GTN after molar evacuation. The decline in serum β-hCG levels during weeks was statistically linked to the development of GTN.
Metrics
References
Khosravirad A, Zayeri F, Baghestani AR, Yoosefi M, Bakhtiyari M. Predictive power of human chorionic gonadotropin in post-molar gestational trophoblastic neoplasia: a longitudinal ROC analysis. Int J Cancer Manag. 2017;10:9.
Riahi R, Rahimiforoushani A, Nourijelyani K, Sharak NA, Bakhtiyari M. Early detection of gestational trophoblastic neoplasia based on serial measurement of human chorionic gonadotrophin hormone in women with molar pregnancy. Int J Prev Med. 2020;11:1-6.
Aminimoghaddam S, Yarandi F, Nejadsalami F, Taftachi F. Human chorionic gonadotrophin as an indicator of persistent gestational trophoblastic neoplasia. Med J Islam Repub Iran. 2014;28:44.
Thomas CM, Kerkmeijer LG, Ariaens HJ, van der Steen RC, Massuger LF, Sweep FC. Pre-evacuation hCG glycoforms in uneventful complete hydatidiform mole and persistent trophoblastic disease. Gynecol Oncol. 2010;117(1):47-52.
Dantas PRS, Maestá I, Rezende Filho J, Junior JA, Elias KM, Howoritz N, et al. Does hormonal contraception during molar pregnancy follow-up influence the risk and clinical aggressiveness of gestational trophoblastic neoplasia after controlling for risk factors? Gynecol Oncol. 2017;147(2):364-70.
Curry SL, Schlaerth JB, Kohorn EI, Boyce JB, Gore H, Twiggs LB, Blessing JA. Hormonal contraception and trophoblastic sequelae after hydatidiform mole (a Gynecologic Oncology Group Study. Am J Obstet Gynecol. 1989;160(4):805-11.
Cole LA. Immunoassay of human chorionic gonadotropin, its free subunits, and metabolites. Clin Chem. 1997;43(12):2233-43.
Kang WD, Choi HS, Kim SM. Prediction of persistent gestational trophoblastic neoplasia: the role of hCG level and ratio in 2 weeks after evacuation of complete mole. Gynecol Oncol. 2012;124(2):250-3.
Tidy J, Hancock BW, Osborne R, Lawrie TA. First‐line chemotherapy in low‐risk gestational trophoblastic neoplasia. Cochrane Database of Systematic Reviews. 2012(7).
van Trommel NE, Sweep FC, Schijf CP, Massuger LF, Thomas CM. Diagnosis of hydatidiform mole and persistent trophoblastic disease: diagnostic accuracy of total human chorionic gonadotropin (hCG), free hCG α- and β-subunits, and their ratios. Eur J Endocrinol. 2005;153(4):565-75.
Kim BW, Cho H, Kim H, Nam EJ, Kim SW, Kim S, et al. Human chorionic gonadotrophin regression rate as a predictive factor of postmolar gestational trophoblastic neoplasm in high-risk hydatidiform mole: a case–control study. Eur J Obstet Gynecol Reprod Biol. 2012;160(1):100-5.
Wolfberg AJ, Feltmate C, Goldstein DP, Berkowitz RS, Lieberman E. Low risk of relapse after achieving undetectable hCG levels in women with complete molar pregnancy. Obstet Gynecol. 2004;104(3):551-4.
Mousavi AS, Karimi S, Modarres Gilani M, Akhavan S, Rezayof E. Does Postevacuation β‐Human chorionic gonadotropin level predict the persistent gestational trophoblastic neoplasia. International Scholarly Research Notices. 2014;4(1):494695.
Sultana A, Pujar LL, Mallapur A. Prediction of complications by serial beta HCG levels in patients with molar pregnancy. Medica. 2020;9(2):109-11.
Neelakanthi A. A prospective clinical study of molar pregnancies in a tertiary care centre at Cheluvamba Hospital, Mysore. Mysore Med College Res Inst. 2014;1-91.
Bakhtiyari M, Mirzamoradi M, Kimyaiee P, Aghaie A, Mansournia MA, Ashrafi-Vand S, Sarfjoo FS. Postmolar gestational trophoblastic neoplasia: beyond the traditional risk factors. Fertil Steril. 2015;104(3):649-54.
Hoeijmakers YM, Eysbouts YK, Massuger LF, Dandis R, Inthout J, van Trommel NE, et al. Early prediction of post-molar gestational trophoblastic neoplasia and resistance to methotrexate, based on a single serum human chorionic gonadotropin measurement. Gynecol Oncol. 2021;163(3):531-7.
Nahar K, Yesmin H, Roy K, Alam S, Khatun K. Experience of persistent gestation trophoblastic disease in a tertiary medical college hospital, Bangladesh. Bangladesh J Obstet Gynaecol. 2012;27(2):50-6.
