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Postevacuation hCG Levels and Risk of Gestational Trophoblastic Neoplasia in Women With Complete Molar Pregnancy

From the ¹Donald P. Goldstein, M.D., Trophoblastic Tumor Registry, New England Trophoblastic Disease Center; ²Division of Gynecologic Oncology, ³Division of Clinical and Epidemiologic Research, and ⁴Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital; ⁵Department of Obstetrics and Gynecology, Massachusetts General Hospital; ⁶Gillette Center for Women's Cancer, Dana Farber Cancer Institute; and ⁷Harvard Medical School, Boston, Massachusetts.

Objectives: Women diagnosed with complete hydatidiform molar pregnancy are at 15% to 28% risk of developing persistent gestational trophoblastic neoplasia (GTN) requiring further management with chemotherapy. Our objective was to develop human chorionic gonadotropin (hCG) criteria that establish a patient's risk of developing persistent GTN or achieving remission from their baseline risk within a few weeks of molar evacuation.

Methods: We used a database from the New England Trophoblastic Disease Center to analyze hCG levels from 1,029 women with complete molar pregnancies. We conducted a retrospective cohort study using data from 1973 to 2001.

Results: Women whose hCG level declined below 50 mIU/mL during their follow-up were found to be at no more than 1.1% risk for developing persistent GTN, irrespective of when this level was reached. Women whose hCG levels was below 200 mIU/mL in the fourth week after evacuation (59.8% of all women), or below 100 mIU/mL in the sixth week after evacuation (65.8% of all women), had a risk of persistence below 9%. hCG levels above 2,000 mIU/mL in the fourth week after evacuation (13.3% of women) were associated with a 63.8% risk of developing persistent disease.

Conclusion: These data may allow clinicians to evaluate the risk of persistence that their patients with complete molar pregnancy have based on early hCG results after molar evacuation. In the fourth week after molar evacuation, 59.8% of women may be counseled that their risk of developing persistent GTN is substantially reduced from their baseline, whereas 13.3% of women may be warned that their risk of developing persistent GTN is greater than 50%.

Level of Evidence: II-2

This article has been cited by other articles:

				I. Niemann, L. K. Petersen, E. S. Hansen, and L. Sunde Predictors of low risk of persistent trophoblastic disease in molar pregnancies. Obstet. Gynecol., May 1, 2006; 107(5): 1006 - 1011. [Abstract] [Full Text] [PDF]

				A. J. Wolfberg, R. S. Berkowitz, D. P. Goldstein, C. Feltmate, and E. Lieberman Postevacuation HCG levels and risk of gestational trophoblastic neoplasia in women with complete molar pregnancy. Obstet. Gynecol., March 1, 2006; 107(3): 743 - 743. [Full Text] [PDF]