High Incidence of Gestational Trophoblastic Disease in a Third-Level University-Hospital, Italy: A Retrospective Cohort Study

Giampiero Capobianco; Elettra Tinacci; Laura Saderi; Francesco Dessole; Marco Petrillo; Massimo Madonia; Giuseppe Virdis; Alessandro Olivari; Davide Adriano Santeufemia; Antonio Cossu; Salvatore Dessole; Giovanni Sotgiu; Pier Luigi Cherchi

doi:10.3389/fonc.2021.684700

High Incidence of Gestational Trophoblastic Disease in a Third-Level University-Hospital, Italy: A Retrospective Cohort Study

Front Oncol. 2021 May 5:11:684700. doi: 10.3389/fonc.2021.684700. eCollection 2021.

Affiliations

¹ Gynecologic and Obstetric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
² Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
³ Institute of Urology, University of Sassari, Sassari, Italy.
⁴ Oncologic Unit, ATS Sardegna, Ospedale Civile Alghero, Sassari, Italy.
⁵ Institute of Pathology, University of Sassari, Sassari, Italy.

Abstract

Introduction: to assess incidence, prognosis and obstetric outcome of patients treated for gestational trophoblastic disease GTD in a twenty-year period. Incidence, prognosis and obstetric outcome of gestational throphoblastic disease.

Methods: retrospective study.

Results: Fifty-four cases of GTD: 46 (85.18%) cases of Hydatidiform mole (HM); 8 cases of Persistent Gestational Trophoblastic Neoplasia (GTN) (14.81%): 6/8 cases (75%) GTN not metastatic; 2/8 cases (25%) GTN metastatic. In both cases, the metastases occurred in the lungs. In 3 out of 8 GTN cases (37.5%) a histological picture of choriocarcinoma emerged. The incidence of GTD cases treated from 2000 to 2020 was 1.8 cases per 1000 deliveries and 1.3 cases per 1000 pregnancies. Of the 54 patients, 30 (55.56%) presented showed normal serum hCG levels without the need for chemotherapy. On the other hand, 24 patients (44.44%) developed a persistent trophoblastic disease and underwent adjuvant therapy. The negative prognostic factors that affected the risk of persistence of GTD were: serum hCG levels at diagnosis > 100,000 mUI/ml; characteristic "snow storm" finding at the ultrasound diagnosis; a slow regression of serum hCG levels during follow-up; the persistence of high serum hCG levels (especially if > 1000 mUI/ml one month after suction curettage) that was the main risk factor for resistance to first-line chemotherapy. There were 10 pregnancies in total following treatment. Patients' survival in our study was 100%.

Discussion: Although GTD is a rare disease, its incidence was 1.3 cases per 1,000 pregnancies in Sardinia, Italy, higher if compared with mean national and worldwide incidence.

Keywords: epidemiology; gestational throphoblastic disease; obstetric outcome; prognostic; serum human chorionic gonadotrophin.