PREDICTORS OF PERSISTENT DISEASE IN WOMEN WITH COMPLETE HYDATIDIFORM MOLE

OBJECTIVE: To determine the most significant factors for persistent di sease in women with hydatidiform mole. STUDY DESIGN: Eighty-two patien ts who were managed consecutively without prophylactic chemotherapy be tween 1973 and 1993 were analyzed retrospectively for clinical and pat hologic features, including age of the patient, size of the uterus, hu man chorionic gonadotropin (hCG) level, presence of theca lutein cysts , evidence of preeclampsia or hyperthyroidism, history of hydatidiform moles, trophoblastic hyperplasia, nuclear atypia, necrosis and hemorr hage, trophoblastic maturation, presence of fibrinoid layer and ratio of cytotrophoblast to syncytial trophoblast. RESULTS: Thirty-one patie nts developed persistent trophoblastic neoplasia (38%). Of the paramet ers evaluated, elevated hCG level, advanced age, history of hydatidifo rm mole, presence of hyperplasia, marked nuclear atypia and necrosis, and hemorrhage were significant risk factors for persistent neoplasia after univariate analysis. Among the factors analyzed, trophoblastic h yperplasia (relative ration [RR] = 3.56), age (RR = 2.87) and history of mole (RR = 2.57) were identified as the most powerful indicators of persistent disease after multivariate analysis. CONCLUSION: Evaluatio n of the clinical and pathologic features, such as age, history of mol e and presence of trophoblastic proliferation may aid in defining a su bset of patients at high risk for persistent disease, who require clos er follow-up and administration of prophylactic chemotherapy.