Ciąża poroniona – Rokowania, prognozy i postęp choroby

Ciąża poroniona
Rokowania, prognozy i postęp choroby

Rokowanie w przypadku ciąży poronionej (molar pregnancy) jest generalnie bardzo dobre, z wysokim wskaźnikiem wyleczenia sięgającym 100% po odpowiednim leczeniu i ewakuacji zmiany. Istotne jest rozróżnienie między całkowitą (CHM) a częściową ciążą poronioną (PHM), gdyż ryzyko rozwoju nowotworu trofoblastycznego (GTN) wynosi odpowiednio około 15-20% i 0,5-1%. Ryzyko rozwoju raka kosmówki po CHM to 23%, a po PHM 1%. Przetrwała choroba trofoblastyczna pojawia się u 0,1-4% kobiet po PHM, najczęściej w ciągu 6-12 miesięcy od ewakuacji. Profilaktyczna chemioterapia (metotreksat, aktynomycyna D, cyklofosfamid) może zmniejszyć ryzyko przetrwałej choroby z 50% do 15%. W przypadku rozwoju GTN, wskaźnik wyleczenia wynosi około 98%, z najlepszymi wynikami w przypadku braku rozprzestrzenienia się tkanki (praktycznie 100%) i niższymi w przypadku wysokiego ryzyka według klasyfikacji FIGO (60-80%).

Ciąża poroniona (Molar Pregnancy) – Rokowanie i przewidywanie wyników leczenia

Wskaźniki wyleczenia w ciąży poronionej
Przetrwała choroba trofoblastyczna
Wskaźniki wyleczenia GTN (nowotwór trofoblastyczny ciążowy)
Stratyfikacja ryzyka w GTN
Porównanie GTN po ciąży poronionej i innych ciążach
Nawroty GTN
Czynniki ryzyka niepomyślnego rokowania
Płodność i przyszłe ciąże
Znaczenie specjalistycznych ośrodków leczenia
Monitorowanie i obserwacja
Kolejne rozdziały

Ciąża poroniona (Molar Pregnancy) – Rokowanie i przewidywanie wyników leczenia

Rokowanie w przypadku ciąży poronionej (molar pregnancy) jest generalnie bardzo dobre, a większość pacjentek osiąga pełne wyleczenie po odpowiednim leczeniu. Jednak, aby dokładnie określić rokowanie, należy uwzględnić szereg czynników prognostycznych oraz możliwość rozwoju powikłań w postaci choroby trofoblastycznej.¹²

Wskaźniki wyleczenia w ciąży poronionej

Wskaźniki wyleczenia w przypadku ciąży poronionej są bardzo wysokie. Po usunięciu (ewakuacji) zmiany większość pacjentek nie wymaga dalszego leczenia i wraca do pełnego zdrowia. W formalnych programach obserwacji po ciąży poronionej, oczekiwany wskaźnik wyleczenia nowotworów trofoblastycznych ciążowych (GTT) powinien wynosić 100%.³⁴

Istotne jest rozróżnienie między całkowitą ciążą poronioną (complete hydatidiform mole, CHM) a częściową ciążą poronioną (partial hydatidiform mole, PHM), ponieważ ryzyko złośliwej transformacji różni się znacząco:⁵

W całkowitej ciąży poronionej (CHM) ryzyko rozwoju nowotworu trofoblastycznego (GTN) wynosi około 15-20%⁶⁷
W częściowej ciąży poronionej (PHM) ryzyko to jest znacznie niższe i wynosi około 0,5-1%⁸⁹

Według danych z badań, ryzyko rozwoju raka kosmówki (choriocarcinoma) po ciąży poronionej jest wyższe dla CHM (23%) niż dla PHM (1%).¹⁰

Przetrwała choroba trofoblastyczna

Przetrwała choroba trofoblastyczna (persistent GTD) występuje po częściowej ciąży poronionej u 0,1-4% kobiet, ale przerzuty są bardzo rzadkie. Najczęściej rozwija się w ciągu 12 miesięcy od ewakuacji, a najczęściej w ciągu pierwszych 6 miesięcy.¹¹

Ciążę poronioną z wysokim ryzykiem przetrwałej choroby cechuje 50% ryzyko utrzymywania się, ale można je zmniejszyć do 15% dzięki profilaktycznej chemioterapii. Wiele ośrodków zaleca rozpoczęcie chemoprofilaktyki natychmiast po ewakuacji, zwykle z zastosowaniem metotreksatu, aktynomycyny D i cyklofosfamidu.¹²

Wskaźniki wyleczenia GTN (nowotwór trofoblastyczny ciążowy)

W przypadku rozwoju nowotworu trofoblastycznego ciążowego (GTN) po ciąży poronionej, rokowanie nadal pozostaje bardzo dobre:¹³

Ogólny wskaźnik wyleczenia GTN wynosi około 98% po zastosowaniu odpowiedniego leczenia¹⁴
GTN po ciąży poronionej jest najlepiej uleczalnym ze wszystkich nowotworów ginekologicznych, z wskaźnikami wyleczenia zbliżającymi się do 100%, nawet w obecności choroby przerzutowej¹⁵¹⁶

Stratyfikacja ryzyka w GTN

Rokowanie w GTN zależy od klasyfikacji ryzyka według systemu FIGO (Międzynarodowa Federacja Ginekologii i Położnictwa):¹⁷¹⁸

Jeśli tkanka ciąży poronionej nie rozprzestrzeniła się: praktycznie 100% wyleczenia
Jeśli tkanka ciąży poronionej rozprzestrzeniła się, ale jest uznawana za niskiego ryzyka: 90-95% wyleczenia
Jeśli rak kosmówki rozprzestrzenił się szeroko i jest uznawany za wysokiego ryzyka: 60-80% wyleczenia

Z danych z badań wynika, że większość pacjentek wymaga jedynie leczenia chemioterapią jednolekową o niskiej toksyczności, podczas gdy 34% pacjentek wymaga chemioterapii skojarzonej, a tylko 2 pacjentki wymagały histerektomii.¹⁹

Porównanie GTN po ciąży poronionej i innych ciążach

Warto zauważyć, że GTN po ciąży poronionej (post-molar GTN) ma lepsze rokowanie niż GTN po innych ciążach (non-molar GTN):²⁰

GTN po ciąży poronionej zwykle jest diagnozowany we wcześniejszym stadium
GTN po innych ciążach częściej występuje w zaawansowanym stadium i z wysokimi wynikami w skali FIGO
GTN po innych ciążach wykazuje wyższy wskaźnik śmiertelności, większe prawdopodobieństwo oporności na chemioterapię pierwszego rzutu i dłuższy czas do osiągnięcia remisji²¹²²

Nawroty GTN

Po skutecznej terapii GTN po ciąży poronionej, nawroty są rzadkie, z ogólnym wskaźnikiem nawrotów wynoszącym około 3,3%. Niski wskaźnik nawrotów i wysoki wskaźnik późniejszego wyleczenia uzasadnia informowanie leczonych pacjentek, że są prawie na pewno wyleczone (97%), ale powinny uczestniczyć w ustrukturyzowanym programie obserwacji hCG ze względu na niewielkie (3%) ryzyko nawrotu.²³

Czynniki ryzyka niepomyślnego rokowania

Kliniczne czynniki, które zostały powiązane z ryzykiem choroby złośliwej to:²⁴

Zaawansowany wiek matki
Wysokie poziomy hCG (100 000 mIU/ml)
Rzucawka
Nadczynność tarczycy
Obustronne torbiele ciałka żółtego

Większość tych czynników wydaje się odzwierciedlać stopień proliferacji trofoblastu. Jednak przewidywanie, u kogo rozwinie się nowotwór trofoblastyczny ciążowy, pozostaje trudne, a decyzje terapeutyczne nie powinny opierać się na obecności któregokolwiek lub wszystkich tych czynników ryzyka.²⁵

Płodność i przyszłe ciąże

Ciąża poroniona zasadniczo nie powoduje niepłodności ani nie prowadzi do powikłań w przyszłych ciążach:²⁶²⁷

Większość kobiet, które miały ciążę poronioną, może później mieć dzieci i nie ma wyższego ryzyka poronienia, powikłań podczas ciąży lub wad wrodzonych u dzieci²⁸²⁹
Ryzyko ponownej ciąży poronionej jest nieznacznie podwyższone, ale nadal wynosi tylko około 1-2%³⁰³¹
Wskaźnik nawrotów po dwóch ciążach poronionych według doniesień waha się od 11 do 25%³²
Po ciąży poronionej zaleca się unikanie ciąży przez okres do trzech miesięcy³³

Badanie Vargas i wsp. wykazało, że u kobiet, które miały ciąże poronione, wyniki kolejnych ciąż są podobne do wyników ciąży w populacji ogólnej.³⁴ Podobnie, badanie Gadducci i wsp. wskazało, że kobiety z nowotworami trofoblastycznymi ciążowymi mają dobre rokowanie, a te, które zachodzą w ciążę po chemioterapii, mają podobne wyniki położnicze do populacji ogólnej.³⁵

Niektóre badania sugerują jednak odmienne wyniki. Raport Joneborg i wsp. sugerował, że po ciąży poronionej zwiększa się ryzyko porodu przedwczesnego. W tym badaniu ryzyko ponownej ciąży poronionej określono na 0,4%.³⁶

Znaczenie specjalistycznych ośrodków leczenia

Ze względu na rzadkość choroby, postępowanie kliniczne i leczenie najlepiej jest prowadzić w specjalistycznych ośrodkach, gdzie można osiągnąć bardzo wysokie wskaźniki wyleczenia.³⁷ Dane z serii przypadków potwierdzają, że wcześniej zgłaszane jednolite wskaźniki wyleczenia pacjentek z GTT po ciąży poronionej wspierają stopniowanie intensywności leczenia przy użyciu systemu punktacji FIGO.³⁸

Monitorowanie i obserwacja

Ścisłe monitorowanie kobiet po ciąży poronionej, z regularnymi pomiarami stężenia gonadotropiny kosmówkowej (hCG), umożliwia wczesne wykrycie nowotworu.³⁹ Diagnoza GTN po ciąży poronionej opiera się głównie na kombinacji wywiadu położniczego i podwyższonych stężeń hCG. Po ciąży poronionej, plateau lub rosnące stężenia hCG wskazują na GTN.⁴⁰

W przypadku przyszłych ciąż po ciąży poronionej, zaleca się wykonanie badania ultrasonograficznego we wczesnym okresie ciąży. Jeśli u kobiety wystąpiły kolejne ciąże poronione, przeprowadza się badania genetyczne.⁴¹

Na ten moment nie ma skutecznego biomarkera prognostycznego, który mógłby konkretnie zidentyfikować te nieliczne kobiety, u których rozwinie się nowotwór po ciąży poronionej i które będą wymagać chemioterapii.⁴²

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Materiały źródłowe

#1 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Most molar pregnancies resolve without treatment after uterine evacuation, but occasionally the disease persists and develops into gestational trophoblastic neoplasia. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] Given the rarity of the disease, clinical management and treatment is best provided in specialist centres where very high cure rates are achievable. […] Both complete and partial moles have the potential for malignant transformation but the risk of GTN is higher for CHM (15-20%) than for PHM (0.5-1%).
#2 Molar Pregnancy: Symptoms, Causes, Types and Risks | Ada
https://ada.com/conditions/molar-pregnancy/
A molar pregnancy, sometimes called a hydatidiform mole, is a rare complication of pregnancy. A molar pregnancy will not develop into a baby. […] A molar pregnancy can be removed, and most people will make a full recovery. Very rarely, it may become cancerous. However, cancers that develop from molar pregnancies tend to have a very good prognosis, with a high cure rate of nearly 100 percent. […] However, GTN has a very good prognosis, with a near 100 percent cure rate. […] After a complete mole, the likelihood of developing GTN is significantly increased. After a partial mole, this risk only increases slightly. […] Yes, a molar pregnancy will not normally cause infertility or lead to complications with future pregnancies. The chances of another molar pregnancy is increased, but is still only around 1-2 percent. The recurrence rate after two molar pregnancies has been reported to range from 11 to 25 percent.
#3 Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000â2009
https://pmc.ncbi.nlm.nih.gov/articles/PMC3504950/
Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. […] Because of the rarity of the diagnosis, detailed structured information on prognosis, treatment escalations and outcome is limited. […] In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. […] The overall results of the low-risk treatment group of patients are shown in Table 3. […] For the 579 FIGO low-risk score patients, 554 patients received first-line treatment with MTX/FA, with 316 patients successfully completing their therapy using this regimen alone, producing an overall successful treatment rate of 57%. […] The majority of patients only required treatment with low-toxicity single-agent chemotherapy, whereas 34% of patients required combination chemotherapy, and only 2 patients required a hysterectomy.
#4 Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000â2009 | British Journal of Cancer
https://www.nature.com/articles/bjc2012462
Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. […] In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. […] The overall results of the low-risk treatment group of patients are shown in Table 3. […] The treatment outcomes of all 618 patients were analysed according to their FIGO prognostic scores as shown in Table 4. […] The standard assessment of GTT patients includes the FIGO prognostic score, which is based on a number of key clinical parameters and allows an estimate of the likely first-line cure rate with the low-intensity single-agent drug treatment. […] Overall, the data in this series confirms that the previously reported uniform cure rates for patients with post-molar pregnancy GTT supports the grading of treatment intensity using the FIGO scoring system, and may be of value to others treating GTT in designing clinical trials, developing centralised treatment centres or updating therapeutic guidelines.
#5 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Most molar pregnancies resolve without treatment after uterine evacuation, but occasionally the disease persists and develops into gestational trophoblastic neoplasia. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] Given the rarity of the disease, clinical management and treatment is best provided in specialist centres where very high cure rates are achievable. […] Both complete and partial moles have the potential for malignant transformation but the risk of GTN is higher for CHM (15-20%) than for PHM (0.5-1%).
#6 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Most molar pregnancies resolve without treatment after uterine evacuation, but occasionally the disease persists and develops into gestational trophoblastic neoplasia. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] Given the rarity of the disease, clinical management and treatment is best provided in specialist centres where very high cure rates are achievable. […] Both complete and partial moles have the potential for malignant transformation but the risk of GTN is higher for CHM (15-20%) than for PHM (0.5-1%).
#7 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/254657-overview
A study by Gadducci et al indicated that women with gestational trophoblastic neoplasia have a good prognosis and that such women who conceive after chemotherapy have similar obstetric outcomes to those of the general population. […] In contrast to the results of the above two studies, a report by Joneborg et al suggested that following a molar pregnancy, the risk of preterm birth is increased. […] The risk of having a repeat molar pregnancy in this study was found to be 0.4%. […] Malignancy is diagnosed in 15-20% of patients with a complete hydatidiform mole and 2-3% of partial moles.
#8 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Most molar pregnancies resolve without treatment after uterine evacuation, but occasionally the disease persists and develops into gestational trophoblastic neoplasia. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] Given the rarity of the disease, clinical management and treatment is best provided in specialist centres where very high cure rates are achievable. […] Both complete and partial moles have the potential for malignant transformation but the risk of GTN is higher for CHM (15-20%) than for PHM (0.5-1%).
#9 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/254657-overview
A study by Gadducci et al indicated that women with gestational trophoblastic neoplasia have a good prognosis and that such women who conceive after chemotherapy have similar obstetric outcomes to those of the general population. […] In contrast to the results of the above two studies, a report by Joneborg et al suggested that following a molar pregnancy, the risk of preterm birth is increased. […] The risk of having a repeat molar pregnancy in this study was found to be 0.4%. […] Malignancy is diagnosed in 15-20% of patients with a complete hydatidiform mole and 2-3% of partial moles.
#10 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
The risk of developing choriocarcinoma after a molar pregnancy is higher for CHM (23%) than PHM (1%). […] The prognosis for women after a molar pregnancy is excellent but some uncertainty remains around the cause of GTD, the risk factors that contribute to malignant transformation, and the optimum surveillance period. […] The increased use of molecular genotyping has improved the diagnostic accuracy of GTD classification, which is critical for prognostic stratification. […] At this time, no effective prognostic biomarker is available to specifically identify those few women who will develop malignancy after molar pregnancy and require chemotherapy.
#11 Azthena logo with the word Azthena
https://www.news-medical.net/health/Molar-Pregnancy-Treatment-and-Prognosis.aspx
Women with a molar pregnancy usually do well after evacuation. GTN may develop in up to 15 of 100 women who had complete moles, and 1 in 200 women with partial moles. GTN has a 98% cure rate following treatment. […] After a complete mole is evacuated, the risk of persistent GTD is 5 times higher. This risk drops somewhat following a hysterectomy. […] Persistent GTD occurs after a partial mole in 0.1-4% of women, but metastasis is very rare. It is most likely to arise within 12 months of evacuation, and most commonly within 6 months. […] High-risk moles have a 50% risk of persistence but this can be reduced to 15% with preventive chemotherapy. Many centers advise starting chemoprophylaxis immediately after evacuation, usually with methotrexate, actinomycin D, and cyclophosphamide.
#12 Azthena logo with the word Azthena
https://www.news-medical.net/health/Molar-Pregnancy-Treatment-and-Prognosis.aspx
Women with a molar pregnancy usually do well after evacuation. GTN may develop in up to 15 of 100 women who had complete moles, and 1 in 200 women with partial moles. GTN has a 98% cure rate following treatment. […] After a complete mole is evacuated, the risk of persistent GTD is 5 times higher. This risk drops somewhat following a hysterectomy. […] Persistent GTD occurs after a partial mole in 0.1-4% of women, but metastasis is very rare. It is most likely to arise within 12 months of evacuation, and most commonly within 6 months. […] High-risk moles have a 50% risk of persistence but this can be reduced to 15% with preventive chemotherapy. Many centers advise starting chemoprophylaxis immediately after evacuation, usually with methotrexate, actinomycin D, and cyclophosphamide.
#13 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Most cases of GTN occur after molar pregnancy but they can also occur after any gestational event, including miscarriage and ectopic or term pregnancies. GTN is the most curable of all gynaecological malignancies with cure rates approaching 100%, even in the presence of metastatic disease. […] The diagnosis of GTN is largely based on a combination of obstetric history and elevated concentrations of hCG. […] After molar pregnancy, plateaued or rising hCG concentrations are indicative of GTN. […] Most women with molar pregnancy do not require further treatment following uterine evacuation of the products of conception. However, some women develop disease persistence and progress to malignant disease requiring chemotherapy or further surgical intervention. […] Women with a molar pregnancy usually present with irregular vaginal bleeding in the first trimester.
#14 Azthena logo with the word Azthena
https://www.news-medical.net/health/Molar-Pregnancy-Treatment-and-Prognosis.aspx
Women with a molar pregnancy usually do well after evacuation. GTN may develop in up to 15 of 100 women who had complete moles, and 1 in 200 women with partial moles. GTN has a 98% cure rate following treatment. […] After a complete mole is evacuated, the risk of persistent GTD is 5 times higher. This risk drops somewhat following a hysterectomy. […] Persistent GTD occurs after a partial mole in 0.1-4% of women, but metastasis is very rare. It is most likely to arise within 12 months of evacuation, and most commonly within 6 months. […] High-risk moles have a 50% risk of persistence but this can be reduced to 15% with preventive chemotherapy. Many centers advise starting chemoprophylaxis immediately after evacuation, usually with methotrexate, actinomycin D, and cyclophosphamide.
#15 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Most cases of GTN occur after molar pregnancy but they can also occur after any gestational event, including miscarriage and ectopic or term pregnancies. GTN is the most curable of all gynaecological malignancies with cure rates approaching 100%, even in the presence of metastatic disease. […] The diagnosis of GTN is largely based on a combination of obstetric history and elevated concentrations of hCG. […] After molar pregnancy, plateaued or rising hCG concentrations are indicative of GTN. […] Most women with molar pregnancy do not require further treatment following uterine evacuation of the products of conception. However, some women develop disease persistence and progress to malignant disease requiring chemotherapy or further surgical intervention. […] Women with a molar pregnancy usually present with irregular vaginal bleeding in the first trimester.
#16 Molar Pregnancy: Symptoms, Causes, Types and Risks | Ada
https://ada.com/conditions/molar-pregnancy/
A molar pregnancy, sometimes called a hydatidiform mole, is a rare complication of pregnancy. A molar pregnancy will not develop into a baby. […] A molar pregnancy can be removed, and most people will make a full recovery. Very rarely, it may become cancerous. However, cancers that develop from molar pregnancies tend to have a very good prognosis, with a high cure rate of nearly 100 percent. […] However, GTN has a very good prognosis, with a near 100 percent cure rate. […] After a complete mole, the likelihood of developing GTN is significantly increased. After a partial mole, this risk only increases slightly. […] Yes, a molar pregnancy will not normally cause infertility or lead to complications with future pregnancies. The chances of another molar pregnancy is increased, but is still only around 1-2 percent. The recurrence rate after two molar pregnancies has been reported to range from 11 to 25 percent.
#17 Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000â2009 | British Journal of Cancer
https://www.nature.com/articles/bjc2012462
Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. […] In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. […] The overall results of the low-risk treatment group of patients are shown in Table 3. […] The treatment outcomes of all 618 patients were analysed according to their FIGO prognostic scores as shown in Table 4. […] The standard assessment of GTT patients includes the FIGO prognostic score, which is based on a number of key clinical parameters and allows an estimate of the likely first-line cure rate with the low-intensity single-agent drug treatment. […] Overall, the data in this series confirms that the previously reported uniform cure rates for patients with post-molar pregnancy GTT supports the grading of treatment intensity using the FIGO scoring system, and may be of value to others treating GTT in designing clinical trials, developing centralised treatment centres or updating therapeutic guidelines.
#18 Molar Pregnancy – Women’s Health Issues – Merck Manual Consumer Version
https://www.merckmanuals.com/home/women-s-health-issues/cancers-of-the-female-reproductive-system/molar-pregnancy
With treatment, many women are cured. The likelihood of cure depends on whether the molar pregnancy tissue has spread and other factors: […] If the molar pregnancy tissue has not spread: Virtually 100% […] If the molar pregnancy tissue has spread but is considered low risk: 90 to 95% […] If the choriocarcinoma has spread widely and is considered high risk: 60 to 80%. […] Most women who have had a molar pregnancy can have children afterward and do not have a higher risk of a miscarriage, complications during pregnancy, or children with birth defects. […] Approximately 1 to 2% of women who have had a molar pregnancy have another one. So if women have had a molar pregnancy, ultrasonography is done early in subsequent pregnancies. If women have consecutive molar pregnancies, genetic testing is done.
#19 Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000â2009
https://pmc.ncbi.nlm.nih.gov/articles/PMC3504950/
Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. […] Because of the rarity of the diagnosis, detailed structured information on prognosis, treatment escalations and outcome is limited. […] In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. […] The overall results of the low-risk treatment group of patients are shown in Table 3. […] For the 579 FIGO low-risk score patients, 554 patients received first-line treatment with MTX/FA, with 316 patients successfully completing their therapy using this regimen alone, producing an overall successful treatment rate of 57%. […] The majority of patients only required treatment with low-toxicity single-agent chemotherapy, whereas 34% of patients required combination chemotherapy, and only 2 patients required a hysterectomy.
#20
http://waocp.com/journal/index.php/apjcc/article/view/273
Non-molar GTN is different from post-molar GTN in several aspects, such as the duration from previous pregnancy, stage and score at diagnosis, treatment resistance and mortality rate. […] Non-molar GTN patients usually present at late stage and high score. Therefore, many works of literature considered non-molar GTN as high risk for chemo-resistance and poor prognosis predictor. […] From the result of our study, non-molar GTN had long time to achieve remission and higher mortality rate compared to post-molar GTN. […] For that reason, non-molar GTN in this study and in the previous studies were diagnosed in advanced stage and high scores and most of them were of high risk for treatment failure. […] Moreover, non-molar GTN in our study showed higher mortality rate, higher chance to resistance to first-line chemotherapy and longer time to achieve remission which was poorer prognosis than post-molar GTN group.
#21
http://waocp.com/journal/index.php/apjcc/article/view/273
Non-molar GTN is different from post-molar GTN in several aspects, such as the duration from previous pregnancy, stage and score at diagnosis, treatment resistance and mortality rate. […] Non-molar GTN patients usually present at late stage and high score. Therefore, many works of literature considered non-molar GTN as high risk for chemo-resistance and poor prognosis predictor. […] From the result of our study, non-molar GTN had long time to achieve remission and higher mortality rate compared to post-molar GTN. […] For that reason, non-molar GTN in this study and in the previous studies were diagnosed in advanced stage and high scores and most of them were of high risk for treatment failure. […] Moreover, non-molar GTN in our study showed higher mortality rate, higher chance to resistance to first-line chemotherapy and longer time to achieve remission which was poorer prognosis than post-molar GTN group.
#22
http://waocp.com/journal/index.php/apjcc/article/view/273
Mortality rate was found in both groups. One case of post-molar GTN and 3 cases of non-molar GTN died. All of them belonged to the high-risk group. […] In conclusion, the overall non-molar GTN has poorer prognosis than post-molar GTN in many aspects such as longer time to achieve remission, higher risk of resistance to first-line treatment and mortality rate.
#23 Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000â2009
https://pmc.ncbi.nlm.nih.gov/articles/PMC3504950/
Overall post-mole GTT is an illness in which the expectation from treatment is one of cure; the data in this study demonstrates in Table 3 that all 618 patients were successfully treated. […] Following successful therapy relapse of post-mole GTT is rare, with the data in Table 6 showing an overall relapse rate of 3.3%. […] The low rate of relapse and high subsequent cure rate supports a policy of informing treated patients that they are almost certainly cured (97%), but that they should take part in a structured hCG follow-up programme because of the small (3%) chance of relapse.
#24 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/254657-overview
Because of early diagnosis and appropriate treatment, the current mortality rate from hydatidiform mole is essentially zero. Approximately 20% of women with a complete mole develop a trophoblastic malignancy. Gestational trophoblastic malignancies (ie, gestational trophoblastic neoplasia) are almost 100% curable. […] Clinical factors that have been associated with risk of malignant disease are advanced maternal age, high levels of hCG (100,000 mIU/mL), eclampsia, hyperthyroidism, and bilateral theca lutein cysts. Most of these factors appear to reflect the amount of trophoblastic proliferation. Predicting who will develop gestational trophoblastic neoplasia remains difficult, and treatment decisions should not be based on the presence of any or all of these risk factors. […] A study by Vargas et al indicated that in women who have had molar pregnancies, the outcomes of subsequent pregnancies are similar to pregnancy outcomes in the general population.
#25 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/254657-overview
Because of early diagnosis and appropriate treatment, the current mortality rate from hydatidiform mole is essentially zero. Approximately 20% of women with a complete mole develop a trophoblastic malignancy. Gestational trophoblastic malignancies (ie, gestational trophoblastic neoplasia) are almost 100% curable. […] Clinical factors that have been associated with risk of malignant disease are advanced maternal age, high levels of hCG (100,000 mIU/mL), eclampsia, hyperthyroidism, and bilateral theca lutein cysts. Most of these factors appear to reflect the amount of trophoblastic proliferation. Predicting who will develop gestational trophoblastic neoplasia remains difficult, and treatment decisions should not be based on the presence of any or all of these risk factors. […] A study by Vargas et al indicated that in women who have had molar pregnancies, the outcomes of subsequent pregnancies are similar to pregnancy outcomes in the general population.
#26 Molar Pregnancy: Symptoms, Causes, Types and Risks | Ada
https://ada.com/conditions/molar-pregnancy/
A molar pregnancy, sometimes called a hydatidiform mole, is a rare complication of pregnancy. A molar pregnancy will not develop into a baby. […] A molar pregnancy can be removed, and most people will make a full recovery. Very rarely, it may become cancerous. However, cancers that develop from molar pregnancies tend to have a very good prognosis, with a high cure rate of nearly 100 percent. […] However, GTN has a very good prognosis, with a near 100 percent cure rate. […] After a complete mole, the likelihood of developing GTN is significantly increased. After a partial mole, this risk only increases slightly. […] Yes, a molar pregnancy will not normally cause infertility or lead to complications with future pregnancies. The chances of another molar pregnancy is increased, but is still only around 1-2 percent. The recurrence rate after two molar pregnancies has been reported to range from 11 to 25 percent.
#27 Molar Pregnancy: Types, Symptoms, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/17889-molar-pregnancy
Most people who receive treatment for a molar pregnancy have no further complications. […] If you have a molar pregnancy, your risk for miscarriage doesn’t increase. […] You’re only at a slightly higher risk of a second molar pregnancy. […] Some people find it helpful to seek genetic counseling before conceiving again. […] There aren’t any indications that a molar pregnancy should affect your decision to try to conceive again if you wish to do so. […] No, it doesn’t cause infertility. […] However, you should avoid becoming pregnant for up to three months. […] A molar pregnancy usually results in the loss of the pregnancy. […] If you’ve had a molar pregnancy in the past, you’re likely to have a healthy pregnancy in the future.
#28 Molar Pregnancy – Women’s Health Issues – Merck Manual Consumer Version
https://www.merckmanuals.com/home/women-s-health-issues/cancers-of-the-female-reproductive-system/molar-pregnancy
With treatment, many women are cured. The likelihood of cure depends on whether the molar pregnancy tissue has spread and other factors: […] If the molar pregnancy tissue has not spread: Virtually 100% […] If the molar pregnancy tissue has spread but is considered low risk: 90 to 95% […] If the choriocarcinoma has spread widely and is considered high risk: 60 to 80%. […] Most women who have had a molar pregnancy can have children afterward and do not have a higher risk of a miscarriage, complications during pregnancy, or children with birth defects. […] Approximately 1 to 2% of women who have had a molar pregnancy have another one. So if women have had a molar pregnancy, ultrasonography is done early in subsequent pregnancies. If women have consecutive molar pregnancies, genetic testing is done.
#29 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/254657-overview
A study by Gadducci et al indicated that women with gestational trophoblastic neoplasia have a good prognosis and that such women who conceive after chemotherapy have similar obstetric outcomes to those of the general population. […] In contrast to the results of the above two studies, a report by Joneborg et al suggested that following a molar pregnancy, the risk of preterm birth is increased. […] The risk of having a repeat molar pregnancy in this study was found to be 0.4%. […] Malignancy is diagnosed in 15-20% of patients with a complete hydatidiform mole and 2-3% of partial moles.
#30 Molar Pregnancy: Symptoms, Causes, Types and Risks | Ada
https://ada.com/conditions/molar-pregnancy/
A molar pregnancy, sometimes called a hydatidiform mole, is a rare complication of pregnancy. A molar pregnancy will not develop into a baby. […] A molar pregnancy can be removed, and most people will make a full recovery. Very rarely, it may become cancerous. However, cancers that develop from molar pregnancies tend to have a very good prognosis, with a high cure rate of nearly 100 percent. […] However, GTN has a very good prognosis, with a near 100 percent cure rate. […] After a complete mole, the likelihood of developing GTN is significantly increased. After a partial mole, this risk only increases slightly. […] Yes, a molar pregnancy will not normally cause infertility or lead to complications with future pregnancies. The chances of another molar pregnancy is increased, but is still only around 1-2 percent. The recurrence rate after two molar pregnancies has been reported to range from 11 to 25 percent.
#31 Molar Pregnancy – Women’s Health Issues – Merck Manual Consumer Version
https://www.merckmanuals.com/home/women-s-health-issues/cancers-of-the-female-reproductive-system/molar-pregnancy
With treatment, many women are cured. The likelihood of cure depends on whether the molar pregnancy tissue has spread and other factors: […] If the molar pregnancy tissue has not spread: Virtually 100% […] If the molar pregnancy tissue has spread but is considered low risk: 90 to 95% […] If the choriocarcinoma has spread widely and is considered high risk: 60 to 80%. […] Most women who have had a molar pregnancy can have children afterward and do not have a higher risk of a miscarriage, complications during pregnancy, or children with birth defects. […] Approximately 1 to 2% of women who have had a molar pregnancy have another one. So if women have had a molar pregnancy, ultrasonography is done early in subsequent pregnancies. If women have consecutive molar pregnancies, genetic testing is done.
#32 Molar Pregnancy: Symptoms, Causes, Types and Risks | Ada
https://ada.com/conditions/molar-pregnancy/
A molar pregnancy, sometimes called a hydatidiform mole, is a rare complication of pregnancy. A molar pregnancy will not develop into a baby. […] A molar pregnancy can be removed, and most people will make a full recovery. Very rarely, it may become cancerous. However, cancers that develop from molar pregnancies tend to have a very good prognosis, with a high cure rate of nearly 100 percent. […] However, GTN has a very good prognosis, with a near 100 percent cure rate. […] After a complete mole, the likelihood of developing GTN is significantly increased. After a partial mole, this risk only increases slightly. […] Yes, a molar pregnancy will not normally cause infertility or lead to complications with future pregnancies. The chances of another molar pregnancy is increased, but is still only around 1-2 percent. The recurrence rate after two molar pregnancies has been reported to range from 11 to 25 percent.
#33 Molar Pregnancy: Types, Symptoms, Causes & Treatments
https://my.clevelandclinic.org/health/diseases/17889-molar-pregnancy
Most people who receive treatment for a molar pregnancy have no further complications. […] If you have a molar pregnancy, your risk for miscarriage doesn’t increase. […] You’re only at a slightly higher risk of a second molar pregnancy. […] Some people find it helpful to seek genetic counseling before conceiving again. […] There aren’t any indications that a molar pregnancy should affect your decision to try to conceive again if you wish to do so. […] No, it doesn’t cause infertility. […] However, you should avoid becoming pregnant for up to three months. […] A molar pregnancy usually results in the loss of the pregnancy. […] If you’ve had a molar pregnancy in the past, you’re likely to have a healthy pregnancy in the future.
#34 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/254657-overview
Because of early diagnosis and appropriate treatment, the current mortality rate from hydatidiform mole is essentially zero. Approximately 20% of women with a complete mole develop a trophoblastic malignancy. Gestational trophoblastic malignancies (ie, gestational trophoblastic neoplasia) are almost 100% curable. […] Clinical factors that have been associated with risk of malignant disease are advanced maternal age, high levels of hCG (100,000 mIU/mL), eclampsia, hyperthyroidism, and bilateral theca lutein cysts. Most of these factors appear to reflect the amount of trophoblastic proliferation. Predicting who will develop gestational trophoblastic neoplasia remains difficult, and treatment decisions should not be based on the presence of any or all of these risk factors. […] A study by Vargas et al indicated that in women who have had molar pregnancies, the outcomes of subsequent pregnancies are similar to pregnancy outcomes in the general population.
#35 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/254657-overview
A study by Gadducci et al indicated that women with gestational trophoblastic neoplasia have a good prognosis and that such women who conceive after chemotherapy have similar obstetric outcomes to those of the general population. […] In contrast to the results of the above two studies, a report by Joneborg et al suggested that following a molar pregnancy, the risk of preterm birth is increased. […] The risk of having a repeat molar pregnancy in this study was found to be 0.4%. […] Malignancy is diagnosed in 15-20% of patients with a complete hydatidiform mole and 2-3% of partial moles.
#36 Hydatidiform Mole: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/254657-overview
A study by Gadducci et al indicated that women with gestational trophoblastic neoplasia have a good prognosis and that such women who conceive after chemotherapy have similar obstetric outcomes to those of the general population. […] In contrast to the results of the above two studies, a report by Joneborg et al suggested that following a molar pregnancy, the risk of preterm birth is increased. […] The risk of having a repeat molar pregnancy in this study was found to be 0.4%. […] Malignancy is diagnosed in 15-20% of patients with a complete hydatidiform mole and 2-3% of partial moles.
#37 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Most molar pregnancies resolve without treatment after uterine evacuation, but occasionally the disease persists and develops into gestational trophoblastic neoplasia. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] Given the rarity of the disease, clinical management and treatment is best provided in specialist centres where very high cure rates are achievable. […] Both complete and partial moles have the potential for malignant transformation but the risk of GTN is higher for CHM (15-20%) than for PHM (0.5-1%).
#38 Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000â2009 | British Journal of Cancer
https://www.nature.com/articles/bjc2012462
Post-molar pregnancy gestational trophoblastic tumours (GTT) have been curable with chemotherapy treatment for over 50 years. […] In the setting of a formal follow-up programme, the expected cure rate for GTT after a molar pregnancy should be 100%. […] The overall results of the low-risk treatment group of patients are shown in Table 3. […] The treatment outcomes of all 618 patients were analysed according to their FIGO prognostic scores as shown in Table 4. […] The standard assessment of GTT patients includes the FIGO prognostic score, which is based on a number of key clinical parameters and allows an estimate of the likely first-line cure rate with the low-intensity single-agent drug treatment. […] Overall, the data in this series confirms that the previously reported uniform cure rates for patients with post-molar pregnancy GTT supports the grading of treatment intensity using the FIGO scoring system, and may be of value to others treating GTT in designing clinical trials, developing centralised treatment centres or updating therapeutic guidelines.
#39 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Gestational trophoblastic disease describes a group of rare pregnancy related disorders that span a spectrum of premalignant and malignant conditions. […] Most molar pregnancies resolve without treatment after uterine evacuation, but occasionally the disease persists and develops into gestational trophoblastic neoplasia. […] Close monitoring of women after molar pregnancy, with regular measurement of human chorionic gonadotrophin concentrations, allows for early detection of malignancy. […] Given the rarity of the disease, clinical management and treatment is best provided in specialist centres where very high cure rates are achievable. […] Both complete and partial moles have the potential for malignant transformation but the risk of GTN is higher for CHM (15-20%) than for PHM (0.5-1%).
#40 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
Most cases of GTN occur after molar pregnancy but they can also occur after any gestational event, including miscarriage and ectopic or term pregnancies. GTN is the most curable of all gynaecological malignancies with cure rates approaching 100%, even in the presence of metastatic disease. […] The diagnosis of GTN is largely based on a combination of obstetric history and elevated concentrations of hCG. […] After molar pregnancy, plateaued or rising hCG concentrations are indicative of GTN. […] Most women with molar pregnancy do not require further treatment following uterine evacuation of the products of conception. However, some women develop disease persistence and progress to malignant disease requiring chemotherapy or further surgical intervention. […] Women with a molar pregnancy usually present with irregular vaginal bleeding in the first trimester.
#41 Molar Pregnancy – Women’s Health Issues – Merck Manual Consumer Version
https://www.merckmanuals.com/home/women-s-health-issues/cancers-of-the-female-reproductive-system/molar-pregnancy
With treatment, many women are cured. The likelihood of cure depends on whether the molar pregnancy tissue has spread and other factors: […] If the molar pregnancy tissue has not spread: Virtually 100% […] If the molar pregnancy tissue has spread but is considered low risk: 90 to 95% […] If the choriocarcinoma has spread widely and is considered high risk: 60 to 80%. […] Most women who have had a molar pregnancy can have children afterward and do not have a higher risk of a miscarriage, complications during pregnancy, or children with birth defects. […] Approximately 1 to 2% of women who have had a molar pregnancy have another one. So if women have had a molar pregnancy, ultrasonography is done early in subsequent pregnancies. If women have consecutive molar pregnancies, genetic testing is done.
#42 Advances in the diagnosis and early management of gestational trophoblastic disease
https://pmc.ncbi.nlm.nih.gov/articles/PMC9978730/
The risk of developing choriocarcinoma after a molar pregnancy is higher for CHM (23%) than PHM (1%). […] The prognosis for women after a molar pregnancy is excellent but some uncertainty remains around the cause of GTD, the risk factors that contribute to malignant transformation, and the optimum surveillance period. […] The increased use of molecular genotyping has improved the diagnostic accuracy of GTD classification, which is critical for prognostic stratification. […] At this time, no effective prognostic biomarker is available to specifically identify those few women who will develop malignancy after molar pregnancy and require chemotherapy.