A multivariate analysis of prognostic indicators in complete hydatidiform moles (CHM).
OBJECTIVE
To analyse prognostic factors in complete hydatidiform moles using multiple logistic regression analysis.


METHODS
Evaluation of host and tumour related parameters including (a) gestational age, patient age, parity, molar phenotype, grade of proliferation of the tumour and cytological atypia, (b) expression of beta-HCG, EGF, EGFR, TGF-alpha, TGF-beta, IL1-alpha, IL1-beta by immunohistochemistry, (c) serial monitoring of serum beta-HCG levels by ELISA, and (d) lectin binding using jack fruit lectin histochemistry as indices for persisting trophoblastic disease (PTD).


RESULTS
Serum beta-HCG levels at 4 weeks, cellular atypia, lectin binding, expression of TGF-alpha and IL1-beta showed highly significant correlation with persistence of the tumour (P<0.001). The sensitivity and specificity at 4 weeks in combination with cytological atypia to identify spontaneously regressing lesions was 100% and those requiring chemotherapeutic intervention was 80%.


CONCLUSIONS
The concentration of serum beta-HCG 4 weeks post evacuation(<300 mIU/ml) combined with cytological abnormalities could identify nearly 100% of the spontaneously regressing lesions (low risk) and 80% of those needing chemotherapeutic intervention (high risk), thereby suggesting that patients who have a serum beta-HCG at 4 weeks of evacuation <300 mIU/ml with no cytological atypia of the trophoblasts need only be followed up at long intervals, while those having a serum beta-HCG at 4 weeks of evacuation >300 mIU/ml accompanied with cytological atypia of the trophoblasts should be closely followed up.
Balaram
P
P
Regional Cancer Centre, Research Division, Kerala, India. rcctvm@md2.vsnl.net.in
John
M
M
Rajalekshmy
T N
TN
Mathew
A
A
Enose
S
S
Gangadharan
V P
VP
D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D007375:Interleukin-1 / Q000097:blood; D037102:Lectins / Q000378:metabolism; D016015:Logistic Models; D015999:Multivariate Analysis; D037121:Plant Lectins; D011247:Pregnancy; D011379:Prognosis; D012680:Sensitivity and Specificity; D016211:Transforming Growth Factor alpha / Q000097:blood; D014594:Uterine Neoplasms / Q000378:metabolism / Q000473:pathology / Q000628:therapy*
D018997:Chorionic Gonadotropin, beta Subunit, Human; D007375:Interleukin-1; D037102:Lectins; D037121:Plant Lectins; D016211:Transforming Growth Factor alpha; C043696:jacalin