Clilnical Factors Associated With Time To HCG Remission In Patients With Gestational Trophoblastic Neoplasia

Background: Gestational trophoblastic neoplasia(GTN)is a potentially life-threatening condition associated with pregnancy.The incidence of GTN in China is relatively high compared to other countries.To date,the treatment of GTN commonly follows The guide of International Federation of Gynecology and Obstetrics(FIGO),One of the aspects that directly affects the treatment plan is the FIGO prognostic scoring system,which includes 8 risk factors.Recently,with the deepening of research,some controversies have arisen.The prognostic score directly determines the treatment plan.Therefore,it is necessary to verify these risk factors and strive to find other possible factors.Human chorionic gonadotropin(hCG)is a reliable and excellent biomarker of the persistence of trophoblastic cells.when trophoblast are not destroyed spontaneously after evacuation of a hydatidiform mole or delivery,causing persistence of hCG and trophoblastic tumor.Chemotherapy drugs can destory hypertrophic trophoblast cells and cause the decline of hCG.Similarly,the decline of hCG can reflect the effectiveness of therapy.Objective: Identify the clinical factors associated with hCG regressiontime among women with GTN to help improve treatment planning and reduce anxiety in patients and their families.Methods: Collected 98 patients from February,2011 and June,2019 admitted to the First Affiliated Hospital of Chongqing Medical University.Associations of time to hCG remission with patient's age,antecedent pregnancy,gravidity,parity,Interval time from index pregnancy,Pretreatment serum hCG,presence of metastatic disease,largest size of tumor,FIGO score,type of therapy,resection of the lesion or not were investigated with univariate and multivariate analysis.Results: The mean hCG regression time was 64 days.Multivariate analysis incorporating the variables significant on univariate analysis confirmed that Non-mole pregnancy(HR 2.08),Largest size of tumor?3cm(HR 1.96),FIGO score ?5(HR 5.87),Serum hCG ?10000 IU/L(HR2.39),Combined therapy(HR 6.31)and resection of the lesion(HR2.36)were associated with longer time to hCG remission.Conclusions: Non-mole pregnancy,higher hCG levels before treatment,Larger size of tumor,higher FIGO score,use of multi-agent therapy and resection of the lesion were independent factors associated with longer time to hCG remission in GTN.