Predictors of persistent disease in women with complete hydatidiform mole

To determine the most significant factors for persistent disease in women with hydatidiform mole.

Eighty-two patients who were managed consecutively without prophylactic chemotherapy between 1973 and 1993 were analyzed retrospectively for clinical and pathologic features, including age of the patient, size of the uterus, human chorionic gonadotropin (hCG) level, presence of theca lutein cysts, evidence of preeclampsia or hyperthyroidism, history of hydatidiform moles, trophoblastic hyperplasia, nuclear atypia, necrosis and hemorrhage, trophoblastic maturation, presence of fibrinoid layer and ratio of cytotrophoblast to syncytial trophoblast.

Thirty-one patients developed persistent trophoblastic neoplasia (38%). Of the parameters evaluated, elevated hCG level, advanced age, history of hydatidiform mole, presence of hyperplasia, marked nuclear atypia and necrosis, and hemorrhage were significant risk factors for persistent neoplasia after univariate analysis. Among the factors analyzed, trophoblastic hyperplasia (relative ration [RR] = 3.56), age (RR = 2.87) and history of mole (RR = 2.57) were identified as the most powerful indicators of persistent disease after multivariate analysis.

Evaluation of the clinical and pathologic features, such as age, history of mole and presence of trophoblastic proliferation may aid in defining a subset of patients at high risk for persistent disease, who require closer follow-up and administration of prophylactic chemotherapy.