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Sixteen Years Experience in Treatment and Follow‐up of Patients with Trophoblastic Diseases *
Author(s) -
Mochizuki Matsuto,
Ashitaka Yoshihiko,
Maruo Takeshi,
Masuko Kazuhisa,
Harada Akira,
Chough SouYong
Publication year - 1984
Publication title -
asia‐oceania journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 0389-2328
DOI - 10.1111/j.1447-0756.1984.tb00020.x
Subject(s) - choriocarcinoma , medicine , molar pregnancy , mole , chorioepithelioma , trophoblastic neoplasm , partial hydatidiform mole , trophoblastic tumor , gynecology , gastroenterology , pregnancy , obstetrics , gestation , fetus , placenta , biology , genetics
From 1967 to 1982, 496 women with trophoblastic diseases received treatment and close follow‐up thereafter at Kobe University Hospital. Of the 306 women who had hydatidiform mole evacuated at our hospital, invasive mole was followed by sequelae in 27 (9.1%), persistent trophoblastic disease (PTD) in 24 (8.1%), and choriocarcinoma in 2 (0.68%). Of the 496, 31 had choriocarcinoma with a survival rate of 51.6% as compared to a survival rate of 95.5% in the remaining patients with 115 invasive moles and with 97 PTDs. All 7 patients with non‐metastatic choriocarcinoma were cured, while 14 (58.3%) out of 24 with metastatic choriocarcinoma died. The poor prognosis in choriocarcinoma resulted from metastases to multiple organs. Of the patients with malignant sequelae, 89.7% (218/243) had hydatidiform mole in the antecedent pregnancy, indicating that it is extremely important to follow‐up patients closely after molar evacuation. The hCG excretion pattern is the most specific prognostic indicator. For routine hCG determination it is convenient to set up the following check points: 1,000 IU/1 at the 4th week, 100 IU/1 at the 6th week and 30 IU/1 at the 8th week following molar evacuation. There was no recurrence of invasive mole and PTD after the diagnosis of remission (less than 5–10 mlU/ml in sera for more than 3 weeks) confirmed by hCG‐beta RIA. However, in one case of choriocarcinoma there was recurrence even after the diagnosis of remission determined by hCG‐beta CTP assay (less than 0.5–1.1 IU/day in urine for more than 3 weeks). Initial chemotherapy given to patients with malignant sequelae should be considered “trial chemotherapy” instead of “primary chemotherapy”, the latter term being reserved for successful initial treatment.