title: Changing presentation of complete hydatidiform mole at the New England Trophoblastic Disease Center over the past three decades: does early diagnosis alter risk for gestational trophoblastic neoplasia?
abstract: OBJECTIVE
  To compare the clinical presentation and incidence of postmolar gestational trophoblastic neoplasia (GTN) among recent (1994-2013) and historical (1988-1993) cases of complete hydatidiform mole (CHM).
  
  
  METHODS
  This study included two non-concurrent cohorts (1988-1993 versus 1994-2013) of patients from the New England Trophoblastic Disease Center (NETDC). Clinical and pathologic reports of patients diagnosed with CHM between 1994 and 2013 were reviewed. Gestational age at evacuation, features of clinical presentation, human chorionic gonadotropin (hCG) levels, and the rate of progression to GTN were compared.
  
  
  RESULTS
  In the current cohort (1994 to 2013) the median gestational age at diagnosis continued to decline compared to our prior cohort (1988-1993) (9weeks versus 12weeks). Patients from the current cohort were significantly more likely to be diagnosed prior to the 11th week of gestation (56 versus 41%, p=0.04). Patients in the current cohort were also significantly less likely to present with vaginal bleeding (46 versus 84%, p<0.001). Earlier diagnosis of complete mole did not result in a decrease in the rate of postmolar GTN. The frequencies of postmolar GTN in the current (1994-2013) and prior (1988-1993) cohorts were 19 and 23%, respectively. In the current cohort, even diagnosis prior to ten weeks gestation did not decrease the risk of developing GTN.
  
  
  CONCLUSIONS
  This study indicates that complete mole continues to be diagnosed progressively earlier resulting in a further decrease in some classical presenting symptoms. However, despite earlier detection, the risk of development of postmolar GTN has not been affected.
authors.affiliation: Department of Obstetrics, Paulista School of Medicine, UNIFESP - São Paulo Federal University, São Paulo, SP, Brazil; Trophoblastic Disease Center of São Paulo Hospital, Paulista School of Medicine, UNIFESP - São Paulo Federal University, São Paulo, SP, Brazil.
authors.forename: Sue Yazaki
authors.initials: SY
authors.lastname: Sun
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD. Trophoblastic Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Melamed
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD. Trophoblastic Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD. Trophoblastic Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA.
authors.forename: Marilyn R
authors.initials: MR
authors.lastname: Bernstein
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD. Trophoblastic Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
authors.affiliation: Department of Obstetrics, Paulista School of Medicine, UNIFESP - São Paulo Federal University, São Paulo, SP, Brazil; Trophoblastic Disease Center of São Paulo Hospital, Paulista School of Medicine, UNIFESP - São Paulo Federal University, São Paulo, SP, Brazil.
authors.forename: Antonio Fernandes
authors.initials: AF
authors.lastname: Moron
authors.affiliation: Department of Gynecology and Obstetrics, Botucatu Medical School, UNESP - São Paulo State University, Botucatu, SP, Brazil; Trophoblastic Diseases Center of the Botucatu Medical School, UNESP - Sao Paulo State University, Botucatu, SP, Brazil.
authors.forename: Izildinha
authors.initials: I
authors.lastname: Maestá
authors.affiliation: Trophoblastic Disease Center of Maternity School of Rio de Janeiro Federal University, Rio de Janeiro, Brazil; Trophoblastic Disease Center of Antonio Pedro University Hospital of Fluminense Federal University, Rio de Janeiro, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Braga
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, USA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD. Trophoblastic Tumor Registry, Boston, USA; Dana Farber Cancer Institute/Harvard Cancer Center, Boston, USA; Harvard Medical School, Boston, USA. Electronic address: rberkowitz@partners.org.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
mesh_terms: D000328:Adult; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015994:Incidence; D009511:New England / Q000453:epidemiology; D011247:Pregnancy; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
keywords: Gestational trophoblastic disease; Gestational trophoblastic neoplasia