[en] [en] BACKGROUND: Amongst complete hydatidiform moles, 15% to 20% will progress to postmolar neoplasia. Scientists have long searched for routinely applicable prognostic markers that can efficiently predict the risk of postmolar neoplasia.
OBJECTIVE: To assess the prognostic value of atypical extravillous trophoblast foci within complete hydatidiform moles on the development of postmolar gestational trophoblastic neoplasia.
STUDY DESIGN: Between January 2017 and December 2022, a retrospective multicenter study was conducted in the Belgian Gestational Trophoblastic Diseases Registry (French-speaking center). All complete hydatidiform moles were included after being confirmed by a systematic centralized pathological review in 3 academic units with a high exposure to placental pathology. Postmolar gestational trophoblastic neoplasia was diagnosed according to the International Federation of Gynecology and Obstetrics 2000 criteria. Atypical extravillous trophoblast foci were defined as trophoblastic clusters in the intervillous chamber with a biphasic pattern of mononucleated cytotrophoblasts and multinucleated syncytiotrophoblasts. Their prognostic value for the development of postmolar gestational trophoblastic neoplasia was assessed using univariate analysis, followed by a multivariate model with stepwise selection of variables having a P value below .10 in the univariate analysis. A risk score, the "R-score," was developed based on the most significant variables of the multivariate model. The intercept and coefficients were obtained by fitting a logistic regression model. To facilitate its use in clinical practice, we established a score ranging from 0 to 10.
RESULTS: Of the 216 patients with complete hydatidiform mole, 56 patients subsequently developed postmolar gestational trophoblastic neoplasia (25.9%). Atypical extravillous trophoblast foci were found in 105/216 cases (48.6%). The risk of postmolar neoplasia was significantly associated with the presence of this pathological feature in univariate analysis (odds ratio, 2.93, P=.0010) and in multivariate logistic regression adjusted for confounding variables (odds ratio, 2.34, P=.0152). The R-score is based on the presence of atypical extravillous trophoblast foci, age, and postevacuation human chorionic gonadotropin levels, with an area under the curve of 0.721. A score below 6 indicates a low risk of postmolar neoplasia (15%), while a score of 7 or higher indicates a high risk (42%).
CONCLUSION: The presence of atypical extravillous trophoblast into complete moles is associated with the risk of developing postmolar gestational trophoblastic neoplasia. These foci may represent a new inexpensive and widely available histological prognostic marker.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics) Laboratory medicine & medical technology
Author, co-author :
Schoenen, Sophie ; Université de Liège - ULiège > Département des sciences cliniques
Delbecque, Katty ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques
Marbaix, Etienne; Department of Pathology Anatomy, University Hospital Saint-Luc, Cliniques Universitaires Saint-Luc (UCL), Brussels, Belgium
Noel, Jean-Christophe; Department of Pathology Anatomy, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
Delvenne, Philippe ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Anatomie et cytologie pathologiques
Seidel, Laurence ; Université de Liège - ULiège > Département des sciences de la santé publique
Van Rompuy, Anne-Sophie; Department of Pathology Anatomy, Leuven Cancer Institute University Hospitals Leuven, KU Leuven, Leuven, Belgium
Van Nieuwenhuysen, Els; Belgium and Luxembourg Gynaecological Oncology Group, Leuven, Belgium, Department of Obstetrics and Gynecology, Gynecologic Oncology, Leuven Cancer Institute University Hospitals Leuven, KU Leuven, Leuven, Belgium
Van Gorp, Toon; Belgium and Luxembourg Gynaecological Oncology Group, Leuven, Belgium, Department of Obstetrics and Gynecology, Gynecologic Oncology, Leuven Cancer Institute University Hospitals Leuven, KU Leuven, Leuven, Belgium
Vergote, Ignace; Belgium and Luxembourg Gynaecological Oncology Group, Leuven, Belgium, Department of Obstetrics and Gynecology, Gynecologic Oncology, Leuven Cancer Institute University Hospitals Leuven, KU Leuven, Leuven, Belgium
Kridelka, Frédéric ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie-Obstétrique
Bolze, Pierre-Adrien; Centre Français de Référence des Maladies Trophoblastiques, CHU Lyon Sud, France
Goffin, Frédéric ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie-obstétrique, partim Gynécologie
We warmly thank the Belgian and Luxembourg Gynecological Oncology Group, the Coll\u00E8ge Royal des Gyn\u00E9cologues Obst\u00E9triciens de la Langue Fran\u00E7aise, and the Vlaamse Vereniging voor Obstetrie en Gynaecologie for hosting the Belgian Gestational Trophoblastic Diseases Registry and for their relentless support. We also acknowledge: the patients for their trust, the data nurses of the 2 centers for their commitment and daily work in collecting patients' records and acquiring the data, and finally our colleagues without whom this work would never have been achieved.
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