| Research Background and Purpose:Gestational trophoblastic diseases(gestationai trophoblastic disease,GTD)include gestational trophoblastic tumors,hydatidiform moles,non-neoplastic diseases,and non-vivo changes.Among them,hydatidiform mole includes complete sex,partial sex and erosive hydatidiform mole.Most of the patients with hydatidiform moles can be cured after early treatment,but there are still some severe potentials of hydatidiform moles.According to the statistical results,patients with complete hydatidiform moles are more prone to malignant changes during clinical follow-up.The probability of biological local tissue infiltration and/or distant anatomical organ metastasis can reach up to 15%and 4%.We judge whether it is a hydatid pregnancy in early pregnancy,mainly through the dynamic observation of human chorionic gonadotropin.For those who have been diagnosed as hydatidiform mole,we should follow up to see if there is a possibility of malignant change.This leads to the clinical diagnosis and treatment of hydatidiform mole degeneration is not timely,patients often cannot get early treatment opportunities.In recent years,the apparent increase in the death rate caused by the deterioration of the hydatidiform mole has become a major problem threatening women’s life and health。At present,in clinical work,hCG is too high,the size of uterus obviously exceeds the number of menopause weeks,imaging examination found that ovarian flavin cyst,and diameter is more than6cm,even older than 40 years of age and previous history of hydatidiform mole,as long as meet one of the above conditions,we can be regarded as a high-risk type of hydatidiform mole,but these conditions cannot be used as a reliable basis for clinical diagnosis and treatment.Therefore,there is still an urgent need to screen out the high risk factors and experimental indicators for early prediction of hydatidiform mole and provide more strong evidence for early diagnosis and treatment of hydatidiform mole.Therefore,this study tries to pass the retrospective score Analysis,from the clinical high risk factors and immunohistochemical indicators to explore a variety of indicators for the predictive value of hydatidiform mole malignant change,is expected to provide a reference for its clinical diagnosis and treatment.Object and Methods:Part I:This section retrospectively analyzes and strictly follows all the cases of hydatidiform moles treated in the hospital of Yiji Mountain affiliated to the Southern Anhui Medical College from January 2006 to February2019(one year after the first negative of hCG after the follow-up period,and ensures complete pathological data),and divides the above cases into the hydatidiform mole group according to the results of follow-up(the cases that have reached the diagnosis of malignant change during the follow-up,including the hCG follow-up results meet the criteria of the diagnosis of tumor cells,the local invasion and distant metastases)and the hydatidatidiform mole group(those who did not change during the follow-up period).Number of days of menopause,size of uterus,first time hCG value in Qinggong,size of hydatidiform mole focus,size of ovarian flavinhua cyst,age of the patient,and no history of hydatidiform mole.The statistical analysis was carried out by SPSS22.0software,the comparison of sample mean was t test,and the comparison of sample rate was X~2 test.By means of logistic regression analysis and ROC curve,the predictive value of each risk factor for the malignant change of hydatidiform mole was determined.Part Ⅱ:The Department of Pathology collected paraffin blocks from all patients in the first section of the first section(to ensure that all samples were not treated with chemotherapy before clearance,and all samples were diagnosed as hydatidiform moles by pathology),reviewed the original sections,identified the obvious wax blocks of trophoblast cells,and performed sections.The expression of P53,P16 and Ki-67 in each section was detected by immunohistochemical method.The expression of each immunohistochemical molecule in the two groups was evaluated according to the ratio of positive cells in the field and the depth of staining.The ratio of the two groups was compared by X2 test.The specificity and sensitivity of each immunohistochemical molecule were evaluated by ROC curve mapping results,and P<0.05 was considered statistically significant.Results:Part Ⅰ:1.Age:The number of cases in the hydatidiformis group(44.8%)older than 40 years was more than that in the hydatid group(23.3%),but the difference was not statistically significant(P=0.103>0.05).uterine size:the number of cases in the uterus in the hydatidiformis group(93.1%)was significantly greater than that in the actual gestational group(70.0%),and the difference was statistically significant(p=0.042<0.05).Menopause weeks:Those with menopause≥12 weeks had more severe hydatidiform mole group(44.8%)than those with hydatidiform mole group(16.7%),with statistical difference(P=0.025%)<0.05).The first Qinggong hCG value:the hCG was greater than 1*10~5U/L,and the hydatidiform mole group(86.2%)was more than the hydatidiform mole group(60.0%),and there was a statistical difference(P=0.039<0.05).The number of cases with ovarian flavinhua cyst diameter>6 cm in the hydatidiformis group(27.6%)was more than that in the hydatidiformis group(3.3%),with statistical difference(P=0.035<0.05).History of hydatidiform mole:There was only one associated history in the hydatidiform mole group,none in the hydatidiform mole group,and there was no significant difference between them(P=0.305<0.05).Grapes fetal lesion size:the mean diameter of each diameter in the hydatid group was57.28+3.99 mm,and that in the hydatid group was 48.47+3.86 mm.there was no significant difference between the two groups(p=0.118<0.05).2.Logistic regression analysis showed that the uterus was significantly higher than the independent high risk factor for gestational degeneration(OR=26.706,P=0.006<0.05),the first time hCG>1*105U/L was the independent high risk factor for gestational degeneration(OR=10.206,P=0.016<0.05),and the ovarian flavin cyst swelling diameter greater than 6cm was an independent risk factor for hydatidiform mole degeneration(OR=23.823,P=0.049<0.05).3.ROC curve analysis:the value of AUC in the ROC curve of uterus was significantly larger than that of gestational week and the first uterine hCG was greater than 1*105 U/L between 0.7 and 0.85,indicating that the above clinical risk factors were good for the prediction of hydatidosis,while the value of AUC in ROC curve with diameter of ovarian flavin cyst larger than 6cm was between 0.5 and 0.7,indicating that it was used for the prediction of hydatidrosis of hydatidatidatidiformis and its accuracy was poor.Part Ⅱ:1.P16:The negative expression of the hydatidiform mole malignant group(58.6%)was significantly higher than that of the hydatid group(23.3%),and there was a statistical difference between the two groups(P=0.006<0.05).P53:There was more positive expression in the hydatidiform mole group(86.2%)than in the hydatidiform mole group(50.0%),with statistical difference(P=0.003<0.05).Ki-67:The positive expression of hydatidiform mole was more in the group(96.6%)than in the group(76.7%),with statistical difference(P=0.026<0.05).2.Logistic regression Analysis:P53,P16 and Ki-67 can be used as independent risk factors for severe hydatidosis.The OR values were:6.615,6.619,15.415,P values:0.008,0.010,0.027,all<0.05.3.ROC curve analysis:The AUC values in the P53 and Ki-67ROC curves ranged from 0.5 to0.7,indicating its poor predictive ability for adverse changes in hydatidiform moles.And P16 cannot be used to predict a bad mole.Conclusion:1.The uterus was significantly larger than gestational week,the number of menopause weeks was greater than or equal to 12 weeks,the first uterine hCG was greater than 1*10~5U/L,and the diameter of flavinhua cyst was more than 6cm.The uterus was significantly larger than gestational week,and the first uterine hCG was more than 1*10~5U/L.2.P16,P53 and Ki-67 are all related to the adverse change of hydatidiform mole and can be used as the malignant change of hydatidiform mole independent risk factors,but none of them could effectively predict the adverse changes in the hydatidiform mole. |
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