title: Effect of race/ethnicity on clinical presentation and risk of gestational trophoblastic neoplasia in patients with complete and partial molar pregnancy at a tertiary care referral center.
abstract: The reported incidence of molar pregnancy varies widely among different geographic locations. This variation has been attributed, at least in part, to racial/ethnic differences. While the incidence of molar pregnancies is decreasing, certain ethnic groups such as Hispanics, Asians, and American Indians continue to have an increased risk of developing gestational trophoblastic disease across the globe.
  
  
  
  We sought to describe the potential effect of ethnicity/race on the presentation and clinical course of complete mole and partial mole.
  
  
  
  All patients followed up for complete mole and partial mole at a single institution referral center from 1994 through 2013 were identified. Variables including age, race, gravidity, parity, gestational age, presenting signs/symptoms, serum human chorionic gonadotropin values, and development of gestational trophoblastic neoplasia were extracted from medical records and patient surveys. Patients with complete mole and partial mole were categorized into race/ethnicity groups defined as white, black, Asian, or Hispanic. Due to low numbers of non-white patients with partial mole in each non-white category, patients with partial mole were grouped as white or non-white. Continuous variables were compared using the Kruskal-Wallis test and binary variables were compared using the Fisher exact test.
  
  
  
  A total of 167 complete mole patients with known race/ethnicity status were included (57.48% white, 14.97% Asian, 14.37% black, 13.17% Hispanic). Hispanics presented at younger age (median 24.5 years) compared to whites (median 32.0 years, P = .04) and Asians (median 31.0 years, P = .03). Blacks had higher gravidity than whites (P < .001) and Hispanics (P = .05). There was no significant difference in presenting symptoms, gestational age at diagnosis, and preevacuation serum human chorionic gonadotropin level by race/ethnicity. Hispanics were significantly less likely than whites to develop gestational trophoblastic neoplasia (absolute risk difference, 28.6%; 95% confidence interval, 8.1-39.2%; P = .02). A total of 144 patients with partial mole were analyzed. There were 108 white and 36 non-white patients. Median age was 31 years for white and 29 years for non-white patients (P = .006). Median gravidity was 2 for white and 3 for non-white patients (P < .001), and median parity was 0 for white patients and 1 for non-white patients (P = .003). There were no significant differences with respect to presenting signs and symptoms, gestational age, preevacuation human chorionic gonadotropin level, or risk of progression to gestational trophoblastic neoplasia.
  
  
  
  Hispanic patients with complete molar pregnancy had a significantly lower risk of developing gestational trophoblastic neoplasia than white patients. There were no significant differences among groups in terms of presenting symptoms, gestational age at diagnosis, or preevacuation human chorionic gonadotropin levels for either complete mole or partial mole patients.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Vincent Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
authors.forename: Allison A
authors.initials: AA
authors.lastname: Gockley
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Vincent Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
authors.forename: Naima T
authors.initials: NT
authors.lastname: Joseph
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Vincent Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Melamed
authors.affiliation: New England Trophoblastic Disease Center, Donald P. Goldstein, MD, Trophoblastic Tumor Registry, Boston, MA; Department of Obstetrics and Trophoblastic Disease Center of São Paulo Hospital, Paulista School of Medicine, São Paulo Federal University, São Paulo, Brazil.
authors.forename: Sue Yazaki
authors.initials: SY
authors.lastname: Sun
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Goodwin
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD, Trophoblastic Tumor Registry, Boston, MA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Bernstein
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Gynecologic Oncology Program, Susan F. Smith Center for Women's Cancers, Dana Farber Cancer Institute/Harvard Cancer Center, Boston, MA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD, Trophoblastic Tumor Registry, Boston, MA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Gynecologic Oncology Program, Susan F. Smith Center for Women's Cancers, Dana Farber Cancer Institute/Harvard Cancer Center, Boston, MA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD, Trophoblastic Tumor Registry, Boston, MA.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA; Gynecologic Oncology Program, Susan F. Smith Center for Women's Cancers, Dana Farber Cancer Institute/Harvard Cancer Center, Boston, MA; New England Trophoblastic Disease Center, Donald P. Goldstein, MD, Trophoblastic Tumor Registry, Boston, MA. Electronic address: nhorotwitz@partners.org.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Horowitz
mesh_terms: D000328:Adult; D005260:Female; D031901:Gestational Trophoblastic Disease / Q000175:diagnosis / Q000208:ethnology*; D020073:Gravidity; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis / Q000208:ethnology*; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000208:ethnology*; D055815:Young Adult
keywords: ethnicity; gestational trophoblastic neoplasia; molar pregnancy; race