Gestational trophoblastic disease: is intensive follow up essential in all women?

OBJECTIVE

To determine the timescale of the registration process for gestational trophoblastic disease and its impact on hCG level at registration and subsequent need for chemotherapy.

DESIGN

A prospective observational study using a standardised protocol for registration, assessment and treatment for molar pregnancy.

SETTING

A supra-regional tertiary referral centre for gestational trophoblastic disease.

PARTICIPANTS

A total of 2046 consecutive women registered between January 1994 and December 1998 with a diagnosis of molar pregnancy.

METHODS

Data at and after registration, collected prospectively on a computerised database, were statistically analysed (by multiple logistic regression and ANOVA).

MAIN OUTCOME MEASURES: Relationship between length of time to and hCG value at registration; also the subsequent need for chemotherapy.

RESULTS

A total of 2046 women with a diagnosis of molar pregnancy were registered in the study period. The mean time interval between first evacuation and registration at the referral centre was 47 days (median 37, range 0-594). One hundred and five out of 2046 (5.1%) women needed chemotherapy. Sixty-three precent of the women (1296 out of 2046) had a normal level of urinary hCG (less than 40 IU/24 hours) at the time of registration and only one (0.08%) needed chemotherapy. Binary logistic regression analysis showed a statistically significant relationship between time to registration, hCG value, histology, pretreatment risk score and decision to administer chemotherapy.

CONCLUSION

Women with gestational trophoblastic disease who were registered late were significantly more likely to have normal levels of hCG and were less likely to need chemotherapy. A less intensive follow up may be justified in women with gestational trophoblastic disease who are registered with a normal hCG level.