title: Influence of hydatidiform mole follow-up setting on postmolar gestational trophoblastic neoplasia outcomes: a cohort study.
abstract: OBJECTIVE
  To assess the influence of hydatidiform mole (HM) management setting (reference center versus other institutions) on gestational trophoblastic neoplasia (GTN) outcomes.
  
  
  METHODS
  This cohort study included 270 HM patients attending Botucatu Trophoblastic Diseases Center (BTDC, São Paulo State University, Brazil) between January 1990 and December 2009 (204 undergoing evacuation and entire postmolar follow-up at BTDC and 66 from other institutions [OIs]). GTN characteristics and outcomes were analyzed and compared according to HM management setting. The confounding variables assessed included age, gravidity, parity, number of abortions and HM type (complete or partial). Postmolar GTN outcomes were compared using Mann-Whitney's test, chi2 test or Fisher's exact test.
  
  
  RESULTS
  Postmolar GTN occurred in 34 (34/204 = 16.7%) BTDC patients and in 27 (27/66 = 40.9%) of those initially treated in other institutions. BTDC patients showed lower metastasis rate (5.8% vs. 48%, p = 0.003) and lower median FIGO (2002) score (2.00 [1.00, 3.00] vs. 4.00 [2.00, 7.00], p = 0.003]. Multiagent chemotherapy to treat postmolar GTN was required in 2 BTDC cases (5.9%) and in 8 OI cases (29.6%) (p = 0.017). Median time interval between molar evacuation and chemotherapy onset was shorter among BTDC patients (7.0 [6.0, 10.0] vs. 10.0 [7.0, 16.0], p = 0.040).
  
  
  CONCLUSIONS
  BTDC patients showed GTN characteristics indicative of better prognosis. This underscores the importance of GTD specialist centers.
authors: Trophoblastic Diseases Center of the Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP-São Paulo State University, Botucatu, SP, Brazil.
authors: Patrícia Rangel Sobral
authors: PR
authors: Dantas
authors: Izildinha
authors: I
authors: Maestá
authors: Rafael
authors: R
authors: Cortés-Charry
authors: Whitfield B
authors: WB
authors: Growdon
authors: Antonio
authors: A
authors: Braga
authors: Marilza Vieira Cunha
authors: MV
authors: Rudge
authors: Ross S
authors: RS
authors: Berkowitz
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D031901:Gestational Trophoblastic Disease / Q000473:pathology* / Q000628:therapy; D006801:Humans; D006828:Hydatidiform Mole / Q000473:pathology* / Q000628:therapy; D009362:Neoplasm Metastasis; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011379:Prognosis; D018570:Risk Assessment; D013997:Time Factors; D014594:Uterine Neoplasms / Q000473:pathology* / Q000628:therapy; D014619:Vacuum Curettage / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin