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Human Chorionic Gonadotropin Follow-up in Patients With Molar Pregnancy: A Time for Reevaluation

From the New England Trophoblastic Disease Center, Donald P. Goldstein, MD Trophoblastic Tumor Registry, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Gillette Center for Women’s Cancer, Dana-Farber Cancer Institute, Dana-Farber Harvard Cancer Center, Harvard Medical School, Boston, Massachusetts; and Department of Obstetrics and Gynecology, National Health Center, Budapest, Hungary.

Address reprint requests to: Ross S. Berkowitz, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115; E-mail: rberkowitz{at}partners.org.

OBJECTIVE: To determine how often patients with molar pregnancy do not complete recommended follow-up and to identify factors that may predict failure to complete human chorionic gonadotropin (hCG) monitoring. This study also sought to determine how often patients with molar pregnancy who do not complete follow-up relapse after attaining at least one undetectable hCG value.

METHODS: Four hundred randomly selected patients with molar pregnancy were analyzed regarding the serum hCG levels after molar evacuation. Demographic factors were determined for each patient: age, marital status, gravidity, parity, health insurance type, and distance from patient residence to trophoblastic center.

RESULTS: Recommended hCG follow-up was completed in 63% of the uncomplicated 333 cases (n = 211). Three hundred twenty patients achieved at least one undetectable serum hCG level. Among the 320 patients, 33% achieved undetectable hCG values but did not complete recommended follow-up. However, none had any evidence of relapse. A distance of greater than 20 miles from the patient’s residence to our center was associated with failure to complete hCG follow-up (P = .001).

CONCLUSION: Because none of the 320 patients who achieved at least one undetectable hCG level has been diagnosed with gestational trophoblastic tumor relapse, it may be appropriate to reassess the duration of hCG monitoring for patients with molar pregnancy.

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