Comparison of beta‑human chorionic gonadotropin‑based prognostic models on the clinical outcomes of gestational trophoblastic disease patients in the Philippines
- Author:
Alvin Duke R. Sy
1
;
Maria Stephanie Fay Samadan Cagayan
2
Author Information
- Publication Type:Journal Article
- Keywords: Beta‑human chorionic gonadotropin
- MeSH: Choriocarcinoma; Gestational Trophoblastic Disease; Prognosis
- From: Philippine Journal of Obstetrics and Gynecology 2023;47(3):99-107
- CountryPhilippines
- Language:English
-
Abstract:
Objective:Despite the widespread use and measurement of beta‑human chorionic
gonadotropin (β‑HCG) among hydatidiform mole (HM) patients, models derived from this biomarker
to predict the remission or postmolar gestational trophoblastic neoplasia (GTN) rarely perform
well. The study aimed to generate cutoff points for postevacuation β‑HCG levels and evaluate their
performance among women with complete molar pregnancies
Methods:A retrospective cohort study composed of women with complete HM underwent bivariate procedures comparing characteristics between the comparison groups. Cut points using Liu’s and Youden’s indices were estimated, and their performance was evaluated using receiver operating characteristic curve analysis. Cox regression to compare time‑to‑progression across these proposed β‑HCG cutoffs was also performed.
Results:The incidence of postmolar GTN among the 155 women in the study was 15.5% (95% confidence interval: 10.2%–22.2%). Postevacuation HCG levels had a better prediction of disease status than preevacuation and HCG ratio models (χ2 : 163.07, P < 0.01). A cutoff at 508 mIU/mL the 3rd‑week postevacuation (area under the curve [AUC]: 0.89, sensitivity: 87.5%, specificity: 90.1%) was comparable with the 185 mIU/mL cutoff at the 5th‑week postevacuation (AUC: 0.89, sensitivity: 91.7%, specificity: 87%). The hazards ratio of postmolar GTN was 29.74 (8.53–103.71) and 39.89 (8.82–180.38) for the 3rd and 5th weeks HCG after evacuation adjusting for clinically relevant variables
Conclusion:The first 3rd‑ and 5th‑week postevacuation levels of β‑HCG demonstrated potential in predicting postmolar GTN. However, further refinement and adjustment for clinically relevant risk factors are still needed. - Full text:comparison_of_beta_human_chorionic.2.pdf
