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#248 How long do we need to monitor HCG after evacuation of a complete hydatidiform mole?
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  1. Leonoor Coopmans1,
  2. Brenna Swift2,
  3. Chris Coyle3,
  4. Xianne Aguiar3,
  5. Naveed Sarwar3,
  6. Kamaljit Singh4,
  7. Matthew Winter4 and
  8. Michael Seckl3
  1. 1The Netherlands Cancer Institute, Amsterdam, The Netherlands
  2. 2University of Toronto, Toronto, Canada
  3. 3Imperial College London, London, UK
  4. 4Sheffield Trophoblastic Disease Centre, Sheffield, UK

Abstract

Introduction/Background In every woman with a hydatidiform mole pregnancy hCG-levels will be monitored after evacuation. If hCG-levels persist or relapse after normalization gestational trophoblastic neoplasia (GTN) is diagnosed and chemotherapeutic treatment is required.

Purpose Following evacuation of a complete hydatidiform mole (CHM), the relative risk of malignant change after hCG normalization is uncertain. Here we examine this question in a large national data-set.

Methodology All registered cases of CHM in the Charing Cross Hospital Trophoblastic Disease Centre database and the Sheffield Trophoblastic Disease Centre were identified from Jan 1, 1980 to Nov 30, 2020. Patients receiving chemotherapy prior to hCG normalization for persistent GTN were excluded. Time to hCG normalization, relapse and treatment for GTN were collected. Pregnancies prior to surveillance completion were collected from Jan 1, 2010 – Nov 30, 2020.

Abstract #248 Table 1

Time to relapse and remaining risk of GTN

Results There were 17 424 patients with normalization of hCG after evacuation of CHM. The risk of relapse was 0.06% (n=3/4804) in patients with hCG normalization within 56 days from evacuation. The time from normalization to relapse ranged from 3.9 to 40.4 months. The risk of relapse was significantly higher at 0.2% (n=26/12620, p=0.038) in women with hCG normalization after 56 days from evacuation with the time from normalization to relapse ranging from 0.1–90.0 months. The majority of relapses (82.8% n=24/29) occurred after the current 6 months surveillance protocol. The risk of relapse after surveillance hCG for 6 months is 1/600, this risk halved to 1/1260 with surveillance until 2 years and halved again to 1/2520 with surveillance to 3 years. All 29 women treated for relapse are currently alive with no disease.

Conclusion Relapse after normalization of hCG with CHM is rare. For patients with hCG normalization within 56 days of evacuation, surveillance protocols can safely change to 1 confirmatory normal hCG.

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