Evaluation of Incidence, Risk Factors, Diagnosis and Management of Gestational Trophoblastic Neoplasia: A Retrospective Study

Abstract

Introduction: Detection of any definite established pattern in aetiological factors can help identify high risk groups among vesicular mole patients, so that the development of Gestational Trophoblastic Neoplasia (GTN) can be anticipated to avoid delay in management of this disease with almost 100% cure rate. Aim: To determine the incidence of GTN, various factors associated with the condition, and any difference in risk factors between low risk and high risk disease and to evaluate the efficacy of the different treatment protocols used. Materials and Methods: A retrospective descriptive study done in the Department of Obstetrics and Gynaecology in a tertiary level hospital in South India which included 100 cases of GTN who were registered in the Gestational Trophoblastic Disease (GTD) clinic for a period of 10 years from January 2002 to December 2011. Data analysis was done from January 2020 to August 2020 The hospital incidence of GTN and proportion of GTN among vesicular mole was calculated. The different socio-demographic factors, clinical features and hormonal profile of all cases of GTN were studied in detail. Results: The incidence of GTN was 0.76 per 1000 deliveries. The proportion of GTN among molar pregnancy was 10.7%. Uterine size greater than period of amenorrhoea, bilateral theca leutin cysts especially with size >6 cm and pre-evacuation human Chorionic Gonadotropin (hCG) >100,000 mIU/mL was associated with development of GTN. GTN was found more in those with complete mole and that was around 71%. Around 81% had low risk GTN and 19% had high risk GTN. Major indication for starting chemotherapy was rising β-hCG (72%). Presence of theca lutein cysts and uterine size greater than period of amenorrhoea were statistically significant risk factors for high risk GTN (p=0.022 and p<0.001, respectively). Conclusion: Identification of risk factors helps in early recognition of GTN and improves the overall outcome. The choice of chemotherapy depends on risk categorisation based on International Federation of Gynaecology and Obstetrics (FIGO) scoring system. Single agent for low risk and combination chemotherapy for high risk group is often sufficient.

Keywords

• beta-human chorionic gonadotrophin
• choriocarcinoma
• persistent trophoblastic disease
• vesicular mole