[Clinical significance of centralized surveillance of hydatidiform mole]

Objective: To explore the clinical significance of centralized surveillance of hydatidiform mole. Methods: From Feb. 2013 to Feb. 2017 all patients with hydatidiform mole, who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and Child Health Care Hospital, were registered centrally for serum hCG monitoring and treatment if necessary. Prophylactic chemotherapy was not administered regardless of risk factors for malignant transformation of hydatidiform mole. The risk factors included age of over 40 years, excessive uterine enlargement for presumed gestational age, a serum hCG level greater than 5 00 000 U/L, large theca lutein ovarian cysts (>6 cm), and a history of previous hydatidiform mole. The centralized surveillance of hydatidiform mole was based on the central pathology review, team cooperation and service improvement. Their treatments and outcomes were analyzed retrospectively. Results: A total of 407 women of hydatidiform mole were registered with histopathology confirmation, including 70 high-risk hydatidiform moles. The follow-up rate was 97.5% (397/407) . The incidence of post-mole neoplasia was 8.1% (32/397) , which was diagnosed in 22.9% (16/70) of high-risk and in 4.9% (16/327) of low-risk hydatidiform moles, showed statistically significant difference between high-risk and low-risk groups (χ(2)=25.108, P<0.01) . Thirty-two patients with post-mole neoplasia were all at low risk of International Federation of Gynecology and Obstetrics (FIGO) score (range, 0-6) and received complete remission with chemotherapy alone in 31 of them except one treated by hysterectomy. The primary cure rate of single-agent chemotherapy was 60.0% (18/30) . Patients with low-risk or high-risk post-mole neoplasia were both 16. There were no significant differences between the two groups in interval that was end of antecedent pregnancy to start of treatment, the serum level of hCG before treatment, clinical stage or risk factor score (all P>0.05) . Conclusions: The risk of malignant transformation is increased in high-risk hydatidiform mole, however, the high risk factor itself does not affect the prognosis in patients with timely diagnosis and treatment of post-mole neoplasia. Therefore, prophylactic chemotherapy is not recommended to high-risk hydatidiform mole patients. Centralized surveillance of hydatidiform mole is practical in a local hospital of China and could greatly improve the prognosis of post-mole neoplasia.