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Women With a Partial Mole During Their First Pregnancy and Diagnosed Earlier in Gestation Are at Increased Risk of Developing Gestational Trophoblastic Neoplasia

Worley, Michael J. Jr MD*†‡§; Joseph, Naima T. MD; Berkowitz, Ross S. MD*†‡§; Goldstein, Donald P. MD*†‡§

International Journal of Gynecological Cancer: June 2014 - Volume 24 - Issue 5 - p 941–945
doi: 10.1097/IGC.0000000000000130
Gestational Trophoblastic Neoplasia

Objective: The aim of this study is to identify factors associated with gestational trophoblastic neoplasia (GTN) after partial molar pregnancy.

Methods: We retrospectively evaluated clinical data from 111 patients with a partial molar pregnancy between 1995 and 2010.

Results: A total of 111 patients with a partial molar pregnancy were available for analysis. There was no significant difference between patients who did and did not develop GTN with respect to patient age, parity, history of prior molar pregnancy, presenting signs/symptoms, uterine size greater than gestational age, clinical diagnosis, preevacuation sonogram findings, or the preevacuation human chorionic gonadotropin value. Patients who developed GTN had fewer prior pregnancies (median, 2 vs 3; P = 0.02) and were more likely to have had a partial molar pregnancy as their first gestational event (37.1% vs 17.1%; P = 0.03). Among the 35 patients who developed GTN, the median time to diagnosis of GTN was 47 days (range, 25–119 days), and the median human chorionic gonadotropin value at the time of GTN diagnosis was 475 mIU/mL (range, 20–52,630 mIU/mL). All women (100%) who developed GTN had stage I disease, and all patients (100%) had low-risk GTN. All 35 women (100%) were able to achieve remission, and most (85.7%) of these patients received methotrexate as first-line chemotherapy.

Conclusions: Women with a partial molar pregnancy as their first gestational event and diagnosed earlier in gestation are more likely to develop postmolar GTN.

*Division of Gynecologic Oncology, Brigham and Women’s Hospital; †New England Trophoblastic Disease Center, Donald P. Goldstein, MD, Trophoblastic Tumor Registry; ‡Dana Farber Cancer Institute/Harvard Cancer Center; §Harvard Medical School; and ∥Brigham and Women’s Hospital/Massachusetts General Hospital Integrated Residency Program in Obstetrics and Gynecology, Boston, MA.

Address correspondence and reprint requests to Ross S. Berkowitz, MD, Division of Gynecologic Oncology, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail: rberkowitz@partners.org.

Presented at the XVII World Congress on Gestational Trophoblastic Disease, Chicago, Ill, September 20 to 23, 2013.

The authors declare no conflicts of interest.

Received January 12, 2014

Accepted February 23, 2014

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.