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

Abstract

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.