Comparison of different therapeutic strategies for complete hydatidiform mole in women at least 40 years old: a retrospective cohort study

Abstract

BackgroundThere are three main therapeutic strategies, namely expectant management (dilation and curettage only), prophylactic chemotherapy and prophylactic total hysterectomy for treating older women with complete hydatidiform mole (CHM). However, the scientific community has so far, not unanimously accepted the above-mentioned methods. The objective of this study was to evaluate the effectiveness of these therapeutic strategies in preventing post-molar gestational trophoblastic neoplasia (GTN) pertaining to patients with CHM who were at least 40 years old.MethodsHundred and seventy-one patients from our hospital who had histologically been diagnosed of CHM and underwent treatment from January 2004 to December 2013 were included. All patients were followed continuously for a minimum of 2 years after which relevant clinical data were extracted and analysed.ResultsAll patients were divided to three groups. Group 1 consisted of 124 patients, treated by expectant management, and the incidence of post-molar GTN was 37.1%. Group 2 included 12 patients who received prophylactic chemotherapy, with an incidence of 41.7%. The remaining 35 patients, Group 3, underwent prophylactic total hysterectomy, with the lowest incidence of 11.4%. A significantly lower incidence was noted in group 3 as compared to group 1 (P = 0.004). GTN patients who received prophylactic chemotherapy required, on average, longer time to be diagnosed of GTN and had higher probability of chemotherapy resistance (P = 0.031 and P = 0.024).ConclusionsThis retrospective analysis showed that prophylactic total hysterectomy was the most effective therapeutic strategy for treating CHM in women at least 40 years old of age.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3749-8) contains supplementary material, which is available to authorized users.

Total hysterectomy versus uterine evacuation for preventing post-molar gestational trophoblastic neoplasia in patients who are at least 40 years old: a systematic review and meta-analysis

“…The participants were at least 40 years old in four studies [14–17], 40 to 49 in one study [13] and 50 or older in one study [12]. All participants were histologically diagnosed with hydatidiform mole consisting of both partial mole and complete mole [14, 16, 17] or only complete hydatidiform mole [12, 13, 15]. The case group included the group of patients who received either hysterectomy [12, 13, 16, 17] or uterine evacuation followed by hysterectomy [14, 15].…”

“…The sample size ranged from 22 to 159. The follow-up period were 3–14 years in one study [14] and 3–12 years in another study [15], while for the other four studies [12, 13, 16, 17], such data were not reported. The outcome of each study was predominantly focused on the incidence of post-molar GTN.…”

“…The outcome of each study was predominantly focused on the incidence of post-molar GTN. A few studies [15, 16] additionally reported other outcomes such as median time to remission, incidence of chemotherapy resistance and time interval for diagnosing GTN. Three studies [14–16] conducted comparisons of clinical characteristics between case group and control group to assess the selection bias, as a result, no selection bias were noted.…”

“…Elias et al [12, 13] reported results regarding to subgroup 1 in 2010 and subgroup 2 in 2012, respectively. Zhao et al [15] reported results of both subgroups in one study in 2017. We extracted the data from the above-mentioned three studies and presented the outcome in Fig.…”

Surgery including fertility-sparing treatment of GTD

“…In contrast, for those women who had dilatation and curettage, GTN developed in 53% and 60% of women aged 40 to 49 years, and ≥50 years respectively [ 22 , 23 ]. Similarly, Zhao et al found that the incidence of post-molar GTN in women aged >40 years was significantly lower in patients who had hysterectomy compared to patients who had dilatation and curettage (11% vs 37%, P =0.004) for complete mole [ 24 ]. In contrast, Giorgione et al reported that in women with hydatidiform mole aged >40 years, primary hysterectomy does not reduce the incidence of port-molar GTN when compared with dilatation and curettage (58% vs 30% respectively, P =0.094) [ 25 ].…”