title: The risk of post-molar gestational trophoblastic neoplasia is higher in heterozygous than in homozygous complete hydatidiform moles.
abstract: BACKGROUND
  Complete hydatidiform mole (CHM) is a high-risk pregnancy for gestational trophoblastic neoplasia (GTN). Patients with CHM have a 10-30% chance of trophoblastic sequelae. CHM includes androgenic homozygous (monospermic) and androgenic heterozygous (dispermic) moles. It is controversial whether the risk of GTN is higher with heterozygous than with homozygous CHM. A prospective cohort study was conducted to assess risk of GTN in homozygous and heterozygous CHM using short tandem repeat (STR) polymorphisms, and a meta-analysis of previous reports.
  
  
  METHODS
  Twenty-eight consecutive molar pregnancies were evacuated and followed by regular hCG measurements to detect GTN. Persistent GTN was diagnosed according to the International Federation of Gynecology and Obstetrics 2000 system. Cytogenesis of the mole was determined by STR polymorphisms of molar tissue and parental blood. A meta-analysis of the GTN rate from previous reports was conducted using Mantel-Haenszel methods.
  
  
  RESULTS
  Of 28 molar pregnancies, 24 were homozygous and three were heterozygous CHM. The remaining mole was diandric triploidy (a partial hydatidiform mole). Of the 24 homozygous CHMs, six (25%) cases developed GTN and received chemotherapy. Meanwhile, all three cases (100%) of heterozygous mole developed GTN and needed chemotherapy. The GTN risk was higher in heterozygous (P = 0.029, Fisher's exact test) than homozygous moles. A systematic review revealed only five previous reports (with more than 15 cytogenetically diagnosed cases), and the pooled relative risk of persistent GTN for heterozygous mole was not significant (odds ratio, 2.0; 95% confidence interval, 0.98-4.07).
  
  
  CONCLUSIONS
  Heterozygous CHM had a higher risk for GTN than homozygous CHM.
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
authors.forename: B
authors.initials: B
authors.lastname: Baasanjav
authors.forename: H
authors.initials: H
authors.lastname: Usui
authors.forename: M
authors.initials: M
authors.lastname: Kihara
authors.forename: H
authors.initials: H
authors.lastname: Kaku
authors.forename: E
authors.initials: E
authors.lastname: Nakada
authors.forename: S
authors.initials: S
authors.lastname: Tate
authors.forename: A
authors.initials: A
authors.lastname: Mitsuhashi
authors.forename: H
authors.initials: H
authors.lastname: Matsui
authors.forename: M
authors.initials: M
authors.lastname: Shozu
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D006828:Hydatidiform Mole / Q000097:blood / Q000145:classification / Q000235:genetics*; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000097:blood / Q000235:genetics*; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin