Impact of clinical characteristics on human chorionic gonadotropin regression after molar pregnancy

Gockley, Allison A.; Lin, Lawrence H.; Davis, Michelle; Melamed, Alexander; Rizzo, Anthony; Sun, Sue Yazaki; Elias, Kevin; Goldstein, Donald P.; Berkowitz, Ross S.; Horowitz, Neil S.

doi:10.6061/clinics/2021/e2830

Allison A. Gockley ^**Corresponding author. E-mail:gockleya@gmail.com

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA.

Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA.

http://orcid.org/0000-0002-4750-5589

Lawrence H. Lin

Department of Pathology, NYU School of Medicine, New York, USA.

Centro de Doencas Trofoblasticas, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

http://orcid.org/0000-0001-9603-9783

Michelle Davis

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA.

Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA.

http://orcid.org/0000-0002-6925-9139

Alexander Melamed

Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA.

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Massachusetts, USA.

http://orcid.org/0000-0002-0654-0863

Anthony Rizzo

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA.

Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA.

http://orcid.org/0000-0002-4559-9569

Sue Yazaki Sun

Centro de Doencas Trofoblasticas, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

http://orcid.org/0000-0001-6573-7386

Kevin Elias

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA.

Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA.

Gynecologic Oncology Program, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, USA.

Trophoblastic Tumor Registry, New England Trophoblastic Disease Center, Boston, USA.

http://orcid.org/0000-0003-1502-5553

Donald P. Goldstein

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA.

Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA.

Gynecologic Oncology Program, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, USA.

Trophoblastic Tumor Registry, New England Trophoblastic Disease Center, Boston, USA.

http://orcid.org/0000-0001-6686-7385

Ross S. Berkowitz

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA.

Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA.

Gynecologic Oncology Program, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, USA.

Trophoblastic Tumor Registry, New England Trophoblastic Disease Center, Boston, USA.

http://orcid.org/0000-0002-7569-898X

Neil S. Horowitz

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, USA.

Department of Obstetrics, Gynecology & Reproductive Biology, Harvard Medical School Boston, MA, USA.

Gynecologic Oncology Program, Susan F. Smith Center for Women’s Cancers, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, USA.

Trophoblastic Tumor Registry, New England Trophoblastic Disease Center, Boston, USA.

http://orcid.org/0000-0002-4854-0642

*Corresponding author. E-mail:gockleya@gmail.com

No potential conflict of interest was reported.

This project was conceived by Gockley AA, Lin LH, Melamed A, Berkowitz RS, Elias K and Horowitz NS. Data collection was completed by Gockley A, Lin LH, Sun SY and Rizzo A. Data analysis was conducted by Melamed A and Rizzo A. Project guidance provided by Berkowitz RS, Horowitz NS, Elias K, Goldstein DP and Davis M. Gockley A and Lin LH wrote the manuscript, which was reviewed by all co-authors.

	Complete mole (n=164)	Partial mole (n=113)	p
Age (years), n (%)			0.006^* * Kruskal-Wallis test
14-19	20 (12.2)	2 (1.8)
20-29	51 (31.1)	35 (31.0)
30-39	76 (46.3)	66 (58.4)
40-53	17 (10.4)	10 (8.8)
Race/Ethnicity, n (%)			<0.001^† † Fisher’s exact test.
White	86 (52.4)	85 (75.2)
Asian	23 (14.0)	1 (0.9)
Hispanic	22 (13.4)	10 (8.8)
Black	20 (12.2)	10 (8.8)
Other/Unknown	13 (7.9)	7 (6.2)
Contraceptive type, n (%)			0.34^† † Fisher’s exact test.
Hormonal	33 (20.1)	30 (26.5)
Non-hormonal	69 (42.1)	39 (34.5)
Unknown	62 (37.8)	44 (38.9)
Body mass index classification, n (%)			0.64^† † Fisher’s exact test.
Non-obese	99 (60.4)	72 (63.7)
Obese	19 (11.6)	9 (8.0)
Unknown	46 (28.0)	32 (28.3)
Gravidity, median (IQR)	2 (1-3)	2 (2-3)	0.16^* * Kruskal-Wallis test
Parity, median (IQR)	0.5 (0-1)	1 (0-1)	0.08^* * Kruskal-Wallis test
Pre-evacuation hCG, median (IQR)	151,815 (75,954-322,957)	108,418 (26,536-282,000)	0.02^* * Kruskal-Wallis test
History of prior mole, n(%)	7 (4.3)	2 (1.8)	0.21^† † Fisher’s exact test.
hCG values, median (IQR)	3 (2-4)	3 (2-3)	0.96^* * Kruskal-Wallis test

	<20 (n=22)	20-29 (n=86)	30-39 (n=142)	≥40 (n=27)	p value
Race/Ethnicity, n(%)					<0.001^† † Fisher exact test
White	10 (45.5)	41 (47.7)	103 (72.5)	17 (63.0)
Asian	1 (4.5)	6 (7.0)	14 (9.9)	3 (11.1)
Hispanic	7 (31.8)	17 (19.8)	5 (3.5)	3 (11.1)
Black	1 (4.5)	15 (17.4)	10 (7.0)	4 (14.8)
Other/Unknown	3 (13.6)	7 (8.1)	10 (7.0)	0 (0)
Gravidity, median (IQR)	1 (1-1)	2 (1-3)	2 (2-3)	3 (2-4)	<0.001^* * Kruskal-Wallis test
Parity, median (IQR)	0 (0-0)	0 (0-1)	1 (0-1)	1 (0-2)	<0.001^* * Kruskal-Wallis test
Preevacuation hCG, median (IQR)	207,761 (87,736-916,197.5)	136,612 (66,623-136,612	128,853 (43,224-284,240	138,741 (82,042-310,073)	0.25^* * Kruskal-Wallis test
Type of Mole, n (%)					0.006^† † Fisher exact test
Complete mole	20 (90.9)	51 (59.3)	76 (53.5)	17 (63.0)
Partial mole	2 (9.1)	35 (40.7)	66 (46.5)	10 (37.0)

	<20	20-29	30-39	≥40	p value^a a Calculated using mixed effects linear regression to account for non-independence of repeated measures.
All moles	3.3 (2.9-3.7)	3.6 (3.4-3.8)	3.7 (3.5-3.8)	3.3 (3.0-3.7)	0.13
Complete mole	3.3 (2.9-3.7)	3.5 (3.2-3.8)	3.5 (3.3-3.7)	3.1 (2.8-3.5)	0.18
Partial mole	---	3.8 (3.4-4.2)	4.0 (3.7-4.2)	3.8 (3.2-4.7)	0.83

	White n=171	Asian n=24	Hispanic n=32	Black n=30	p value
Age, median (IQR)	32 (29-35)	31.5 (26.5-36)	24.5 (20.5-31.5)	29 (25-35)	0.001^* * Kruskal-Wallis test
Gravidity, median (IQR)	2 (1-3)	2 (1.5-3)	2 (1-4)	3 (2-4)	0.01^* * Kruskal-Wallis test
Parity, median (IQR)	1 (0-1)	0 (0-1)	1 (0-2)	1 (0-2)	0.05^* * Kruskal-Wallis test
Pre-evacuation hCG, median (IQR)	137,875 (665,425-325,445)	226,591 (108,084-345,760)	100,711 (41,655-310,3000	82,399 (26,536-156,082)	0.08^* * Kruskal-Wallis test
Type of Mole, n (%)					<0.001^† † Fisher exact test
Complete mole	86 (50.3)	23 (95.8)	22 (68.7)	20 (66.7)
Partial mole	85 (49.7)	1 (4.2)	10 (31.3)	10 (33.3)
History of prior mole, n (%)	3 (1.8)	3 (12.5)	1 (3.1)	1 (3.3)	0.05^† † Fisher exact test
hCG measurements	3 (2-4)	3 (2.5-4)	3 (2-3.5)	2.5 (2-3)	0.09^* * Kruskal-Wallis test

	All races	White	Asian	Hispanic	Black	p value^a a Calculated using mixed effects linear regression to account for non-independence of repeated measures.
All moles	3.6 (3.5-3.7)	3.7 (3.5-3.8)	3.2 (2.9-3.7)	3.8 (3.4-4.3)	3.4 (3.0-3.9)	0.16
Complete mole	3.4 (3.3-3.6)	3.5 (3.3-3.7)	3.2 (2.9-3.7)	3.8 (3.3-4.4)	3.3 (2.8-4.1)	0.51
Partial mole	3.9 (3.6-4.1)	3.9 (3.7-4.3)	3.7 (3.5-3.9)	3.8 (3.3-4.6)	3.3 (2.8-4.5)	0.41

	Non-obese (BMI <30kg/m2) n=171	Obese (BMI ≥30kg/m2) n=28	p value
Age, median (IQR)	30 (24-34)	30.5 (27.5-36)	0.28^* * Kruskal-Wallis test
Race/Ethnicity, n(%)			0.007^† † Fisher exact test
White	109 (63.7)	13 (46.4)
Asian	17 (9.9)	1 (3.6)
Black	14 (8.2)	9 (32.1)
Hispanic	22 (12.9)	5 (17.9)
Unknown/Other	9 (5.3)	0 (0)
Gravidity, median (IQR)	2 (1-3)	2 (1.5-4)	0.30^* * Kruskal-Wallis test
Parity, median (IQR)	1 (0-1)	1 (0-2)	0.20^* * Kruskal-Wallis test
Pre-evacuation hCG, median (IQR)	138,709 (53,738.5-336,870)	146,054 (54,786-320,000)	0.80^* * Kruskal-Wallis test
Type of Mole, n (%)			0.41^† † Fisher exact test
Complete mole	99 (57.9)	19 (67.9)
Partial mole	72 (42.1)	9 (32.1)
History of prior mole, n (%)	7 (4.1)	1 (3.6)	1.0^† † Fisher exact test
hCG measurements, median (IQR)	3 (2-4)	3 (2-3.5)	0.42^* * Kruskal-Wallis test

	Non-obese (BMI <30kg/m²)	Obese (BMI ≥30kg/m²)	p value^a a Calculated using mixed effects linear regression to account for non-independence of repeated measures.
All moles	3.7 (3.5-3.8)	3.2 (2.9-3.6)	0.02
Complete moles	3.6 (3.4-3.8)	3.2 (2.8-3.7)	0.19
Partial moles	3.9 (3.6-4.2)	3.2 (2.7-3.9)	0.03

	Hormonal contraception n=107	Non-hormonal contraception n=63	p value
Age, median (IQR)	29 (22-34)	32 (30-36)	<0.001^* * Kruskal-Wallis test
Race/Ethnicity, n(%)			0.004^† † Fisher exact test
White	58 (56.9)	45 (71.4)
Asian	6 (5.6)	9 (14.3)
Black	21 (19.6)	3 (4.8)
Hispanic	17 (15.9)	5 (7.9)
Unknown	5 (4.7)	1 (1.6)
Gravidity, median (IQR)	2 (1-3)	2 (1-3)	0.77^* * Kruskal-Wallis test
Parity, median (IQR)	0.5 (0-1)	1 (0-1)	0.52^* * Kruskal-Wallis test
Pre-evacuation hCG, median (IQR)	148,088 (51,114-363,450)	133,844 (51,192-327,932)	0.71^* * Kruskal-Wallis test
Type of Mole, n (%)			0.20^† † Fisher exact test
Complete mole	68 (63.5)	33 (52.4)
Partial mole	39 (36.5)	30 (47.6)
History of prior mole, n (%)	3 (2.8)	2 (3.2)	1.0^† † Fisher exact test

	Hormonal contraception	Non-hormonal contraception	p value^a a Calculated using mixed effects linear regression to account for non-independence of repeated measures.
All moles	3.4 (3.2-3.6)	4.0 (3.7-4.3)	0.002
Complete moles	3.4 (3.2-3.6)	3.6 (3.3-4.0)	0.32
Partial moles	3.4 (3.2-3.7)	4.7 (4.1-5.5)	<0.001

[1] *Corresponding author. E-mail:gockleya@gmail.com

Brasil

Brasil

Impact of clinical characteristics on human chorionic gonadotropin regression after molar pregnancy

OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION: