J Gynecol Oncol.  2019 Mar;30(2):e16. 10.3802/jgo.2019.30.e16.

The management of hydatidiform mole with lung nodule: a retrospective analysis in 53 patients

Affiliations
  • 1Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China. 5198008@zju.edu.cn
  • 2Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
  • 3Obstetrics and Gynecology, Hangzhou Red Cross Hospital, Hangzhou, China.
  • 4Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Hangzhou, China.

Abstract


OBJECTIVE
To investigate the significance of lung nodule in hydatidiform mole, we retrospectively compared the clinical outcomes of those patients treated with different strategies.
METHODS
The patients were divided into three groups: chemotherapy immediately once lung nodule was detected (group 1, n=17), delayed chemotherapy until human chorionic gonadotrophin (hCG) level met the diagnostic criteria for gestational trophoblastic neoplasia (GTN) (group 2, n=18), and hCG surveillance alone until hCG level was normalized spontaneously (group 3, n=18). The clinical parameters of these patients were collected and analyzed.
RESULTS
Totally 53 (4.0%) patients were included from 1,323 cases with molar pregnancy during past 16 years. Among them, the diameters of lung nodules were 0.3-2.5 cm. Chemotherapy cycles for achieving hCG normalization and the failure rate of first-line chemotherapy in group 1 were significantly increased than that in group 2 (5 vs. 3 cycles, p=0.000, 58.8% vs. 11.1%, p=0.005). The hCG level of all 18 cases in group 3 was normalized spontaneously within 6 months. Of those, lung nodules of 9 patients disappeared spontaneously, accounting for 25% (9/36) of patients who initially selected observation. The proportion of single nodule in group 3 was significantly higher than that in group 2 (10/18 vs. 2/18, p=0.012).
CONCLUSIONS
Our results suggest that lung nodule alone is not an adequate indication of chemotherapy in molar pregnancy. hCG surveillance is safe for patients with lung nodule, especially with single nodule, as long as their hCG levels do not meet International Federation of Gynecology and Obstetrics diagnostic criteria for GTN.

Keyword

Hydatidiform Mole; Pulmonary Nodule; Chemotherapy; Gestational Trophoblastic Neoplasia; Chorionic Gonadotrophin

MeSH Terms

Chorion
Drug Therapy
Female
Gestational Trophoblastic Disease
Gynecology
Humans
Hydatidiform Mole*
Lung*
Obstetrics
Pregnancy
Retrospective Studies*

Figure

  • Fig. 1. The chemotherapy response for patients in group 1 and 2. (A) More chemotherapy cycles for achieving human chorionic gonadotrophin normalization were used in group 1 than that in group 2. (B) More failure rate of first-line chemotherapy in group 1 than that in group 2.


Reference

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