Early identification of persistent trophoblastic disease with serum hCG concentration ratios

Abstract

The objective of the present study was to assess the diagnostic potential of serum human chorionic gonadotropin (hCG) ratios obtained at different intervals after evacuation of hydatidiform mole to diagnose persistent trophoblastic disease (PTD) and to compare its diagnostic accuracy with the current FIGO 2000 criteria as a gold standard. We calculated hCG ratios from serum hCG concentrations of 204 patients (86 with and 118 without PTD) registered with the Dutch Central Registry for Hydatidiform Moles between 1977-2004. The hCG ratios obtained in week 1, 3, and 5 after evacuation identified, respectively, 20%, 52%, and 79% of patients with PTD (median: 3.0 weeks) at the 95% specificity level, while FIGO 2000 criteria identified, respectively, 0%, 16%, and 66% (median: 4.7 weeks). It is concluded that a serum hCG ratio identifies patients with PTD approximately 2 weeks earlier than the internationally accepted FIGO 2000 criteria and identifies more than 75% of patients who develop PTD by the fifth week after evacuation.

Linear Regression of Postevacuation Serum Human Chorionic Gonadotropin Concentrations Predicts Postmolar Gestational Trophoblastic Neoplasia

“…12 The hCG ratios obtained from postevacuation hCG levels (dividing the first available hCG concentration of a specimen taken within the first 2 weeks after evacuation by the hCG concentration of a specimen taken in the following weeks) showed an increasing diagnostic potential. 13 Recently, Kim et al 26 showed that GTN could be predicted by the hCG regression rate obtained by dividing the hCG by the initial hCG with a sensitivity of 48.0% and specificity of 89.5% (AUC, 0.759) in the second week after evacuation, although only patients were selected with an initial hCG level of more than 100,000 IU/L.…”

Human Chorionic Gonadotropin (hCG) Regression Curve for Predicting Response to EMA/CO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine) Regimen in Gestational Trophoblastic Neoplasia

“…To avoid the risk of ineffective cycles of chemotherapy, many studies attempted to develop new methods to enable early identification of chemoresistance in low-risk GTN such as an hCG regression nomogram (van Trommel et al, 2006) and serum hCG concentration ratios (van Trommel et al, 2008). Unfortunately, there is a lack of studies in patients with high-risk GTN.…”

Predictive Power of Human Chorionic Gonadotropin in Post-Molar Gestational Trophoblastic Neoplasia: A Longitudinal Roc Analysis

“…For instance, in a study conducted by Van Trommel et al, they calculated hCG ratios from serum hCG concentrations for 204 patients with and without persistent trophoblastic disease (PTD). The hCG ratios obtained in week 1, 3, and 5 after evacuation identified, respectively, 20%, 52%, and 79% of patients with PTD (11). However, the present study gives more accurate discrimination (above 90%), using the three-week trend of β-hCG levels.…”

“…In the previous decade, a number of studies have been conducted to find some indicators for early prediction of GTN. For instance, some research indicated that the ratio of β-hCG concentration before and after molar pregnancy or the ratios of hCGα-and β-subunits may lead to better early prediction of GTN (10)(11)(12). In addition, in another study, the researchers used the slope of linear regression between logβ-hCG and time (in week) and regression curve for this purpose (13)(14)(15).…”