| Objective To evaluate the clinical feature, methods of diagnosis, therapy of response by comparing the antecedent molar pregnancy with nonmolar pregnancy in the gestational trophoblastic tumour.Material and methods Retrospective analysis the clinical data of 232 cases who diagnosed as gestational trophoblastic tumor from June 1st,2004 to June 1st,2009 in Women's Hospital affiliated School of Medicine of Zhejiang University, and discuss the relevant literature with these cases.Results There are 128 complete hydatidiform mole,23 partial hydatidiform mole in the antecedent pregnancies. The other 12 patients were diagnosed hydatidiform mole in the local hospital without histology diagnosis. So there are 29.7%(69/232) nonmolar and 70.3%(163/232) molar pregnant in the GTT.9.4%(23/245) term,19.2%(47/245) abortion and 0.4%(1/245) ectopic pregnant in the antecedent of the nonmolar pregnancy. In all the hydatidiform mole blood or urine HCG of 7 persons are negative. The maternal median age is 29 in the nonmolar while it's 28 in the molar pregnancy. The maternal age is no significant difference between the two groups (P=0.89). The median interval from molar pregnancy is 1.5 months, the interval from nonmolar was 4.5 months, the time was significant difference (P<0.001).27.6%(45/163) have vaginal bleeding and 65.6%(107/163) have asymptomatic sign (patients who just have menopause are also included) in the postmolar GTT,68.1%(47/69) have vaginal bleeding and 27.5%(19/69) have asymptomatic (patients who just have menopause are also included) sign in the postnonmolar GTT. The GTT clinical performance is in a significant difference (P<0.001).96.9%(158/163) diagnose GTT in the antecedent of molar by HCG, while 92.7%(64/69) in the nonmolar pregnancy.64.4%(105/163) diagnose GTT in the antecedent of molar by HCG and images, while 43.5%(30/69) in the nonmolar pregnancy. There was no significant difference (P= 0.0991) in diagnosing by HCG, but significant difference (P= 0.0031) in diagnosing by both. The distribution of staging between the two groups was no significant difference (P= 0.0836).8.0% (13/163) is high risk in the postmolar GTT,43.1%(25/58) in the postnonmolar GTT, there is the significantly different (P<0.001) in the two groups.62.9%(80/127) is relief by using MTX in the low risk of postmolar GTT,73.9%(34/46) remission when changing into ACTD.66.7%(16/24) is relief by using MTX in the low risk of postnonmolar GTT,80%(4/5) remission when changing into ACTD. There isn't the significantly different (P= 0.898) in initial therapy of the two groups, no statistical differences (P= 0.458) by changing into ACTD. There's no statistical differences (P= 0.6055) by initial therapy of EMA-CO in the post-molar and post-non-molar of GTT.Conclusion Gestational trophoblastic tumor mainly secondary to mole. The maternal age in postmolar and postnonmolar GTT is no significant difference, but the median interval from molar pregnancy was shorter than the nonmolar pregnancy. The common symptom is vaginal bleeding in the postnonmolar GTT, while the common symptom is no sign in postmolar GTT. The diagnosis need to follow the HCG in the both groups. In the low risk the remission of the two groups isn't significant difference, also significant difference after changing into ACTD, the remission of the two groups isn't significant difference in the high risk, indicating that chemotherapy based on prognostic score is a reliable choice. |
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