title: Gestational trophoblastic neoplasia after spontaneous human chorionic gonadotropin normalization following molar pregnancy evacuation.
abstract: OBJECTIVE
  To evaluate the risk of gestational trophoblastic neoplasia (GTN) after spontaneous human chorionic gonadotropin normalization in postmolar follow-up.
  
  
  METHODS
  Retrospective chart review of 2284 consecutive cases of hydatidiform mole with spontaneous normalization of hCG following uterine evacuation treated at one of five Brazilian reference centers from January 2002 to June 2013.
  
  
  RESULTS
  After hCG normalization, GTN occurred in 10/2284 patients (0.4%; 95% CI 0.2%-0.8%). GTN developed in 9/1424 patients (0.6%; 95% CI 0.3%-1.2%) after a complete hydatidiform mole, in 1/849 patients (0.1%; 95% CI<0.01%-0.7%) after a partial hydatidiform mole, and in 0/13 patients (0%; 95% CI 0%-27%) after a twin molar pregnancy. The median time to GTN diagnosis after hCG normalization was 18months, and no diagnoses were made before six months of postmolar surveillance. Patients who required more than 56days to achieve a normal hCG value had a ten-fold increased risk of developing GTN after hCG normalization (9/1074; 0.8%; 95% CI 0.4%-1.6%) compared to those who reached a normal hCG level in fewer than 56days (1/1210;0.08%; 95% CI<0.01%-0.5%; p=0.008). All patients presented with symptoms at the time of GTN diagnosis.
  
  
  CONCLUSIONS
  GTN after spontaneous hCG normalization following molar pregnancy is exceedingly rare, and the few patients who do develop GTN after achieving a normal hCG value are likely to be diagnosed after completing the commonly recommended six months of postmolar surveillance. Current recommendations for surveillance after hCG normalization should be revisited.
authors.affiliation: Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University, Maternity Ward of Santa Casa da Misericórdia do Rio de Janeiro), Laranjeiras, Rio de Janeiro, Brazil; Professional Master's Program in Maternal and Child Health, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
authors.forename: Antonio
authors.initials: A
authors.lastname: Braga
authors.affiliation: Botucatu Trophoblastic Disease Center, São Paulo State University, Botucatu, Brazil.
authors.forename: Izildinha
authors.initials: I
authors.lastname: Maestá
authors.affiliation: Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University, Antonio Pedro University Hospital of Fluminense Federal University, Maternity Ward of Santa Casa da Misericórdia do Rio de Janeiro), Laranjeiras, Rio de Janeiro, Brazil; Professional Master's Program in Maternal and Child Health, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.
authors.forename: Michelle
authors.initials: M
authors.lastname: Matos
authors.affiliation: New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: kelias1@partners.org.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Elias
authors.affiliation: Goiás Trophoblastic Disease Center, Goiás Federal University, Goiânia, Brazil.
authors.forename: Julianna
authors.initials: J
authors.lastname: Rizzo
authors.affiliation: Goiás Trophoblastic Disease Center, Goiás Federal University, Goiânia, Brazil.
authors.forename: Maurício Guilherme Campos
authors.initials: MG
authors.lastname: Viggiano
mesh_terms: D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D015331:Cohort Studies; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000453:epidemiology*; D006801:Humans; D006828:Hydatidiform Mole / Q000097:blood / Q000473:pathology / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D011247:Pregnancy; D059285:Pregnancy, Twin; D012189:Retrospective Studies; D013997:Time Factors; D014594:Uterine Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D014619:Vacuum Curettage; D055815:Young Adult
chemical_list: D006063:Chorionic Gonadotropin
keywords: Gestational trophoblastic disease; Gestational trophoblastic neoplasia; Human chorionic gonadotropin; Molar pregnancy; Recrudescent disease