Journal List > J Gynecol Oncol > v.30(2) > 1116853

Li, Xu, Liu, Cheng, Wang, Lu, and Xie: The management of hydatidiform mole with lung nodule: a retrospective analysis in 53 patients



To investigate the significance of lung nodule in hydatidiform mole, we retrospectively compared the clinical outcomes of those patients treated with different strategies.


The patients were divided into three groups: chemotherapy immediately once lung nodule was detected (group 1, n=17), delayed chemotherapy until human chorionic gonadotrophin (hCG) level met the diagnostic criteria for gestational trophoblastic neoplasia (GTN) (group 2, n=18), and hCG surveillance alone until hCG level was normalized spontaneously (group 3, n=18). The clinical parameters of these patients were collected and analyzed.


Totally 53 (4.0%) patients were included from 1,323 cases with molar pregnancy during past 16 years. Among them, the diameters of lung nodules were 0.3–2.5 cm. Chemotherapy cycles for achieving hCG normalization and the failure rate of first-line chemotherapy in group 1 were significantly increased than that in group 2 (5 vs. 3 cycles, p=0.000, 58.8% vs. 11.1%, p=0.005). The hCG level of all 18 cases in group 3 was normalized spontaneously within 6 months. Of those, lung nodules of 9 patients disappeared spontaneously, accounting for 25% (9/36) of patients who initially selected observation. The proportion of single nodule in group 3 was significantly higher than that in group 2 (10/18 vs. 2/18, p=0.012).


Our results suggest that lung nodule alone is not an adequate indication of chemotherapy in molar pregnancy. hCG surveillance is safe for patients with lung nodule, especially with single nodule, as long as their hCG levels do not meet International Federation of Gynecology and Obstetrics diagnostic criteria for GTN.


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Fig. 1.
The chemotherapy response for patients in group 1 and 2. (A) More chemotherapy cycles for achieving human chorionic gonadotrophin normalization were used in group 1 than that in group 2. (B) More failure rate of first-line chemotherapy in group 1 than that in group 2.
Table 1.
The clinical characteristics of patients in three groups
Variables Group 1 (n=17) Group 2 (n=18) Group 3 (n=18) p-value
Age (yr) 26 (17–53) 29.5 (17–53) 31.5 (16–54) 0.369
hCG level of pre-evacuation (IU/L) 464,672.0 (50,138.0–2,004,065.0) 152,386.0 (1,000.0–1,000,000.0) 140,880.5 (14,812.9–431,000.0) 0.107
Gestational age (day) 74 (46–147) 71 (37–270) 69 (30–112) 0.111
Pathology of molar pregnancy       0.231
 CHM 17 16 15  
 PHM 0 2 3  
Detected time of lung nodule*       0.281
 At evacuation 12 11 8  
 After evacuation 5 7 10  
The largest diameter of lung nodule (cm) 0.6 (0.3–1.7) 0.6 (0.3–2.5) 0.65 (0.3–1.7) 0.946
The quantity of lung nodule       0.018
 Single 7 2 10  
 Multiple 10 16 8  

Values are presented as median (range) or number. CHM, complete hydatidiform mole; hCG, human chorionic gonadotrophin; PHM, partial hydatidiform mole.

* This variable means the number of patients whose lung nodule detected at evacuation or after evacuation;

The p-value for the difference of the quantity of lung nodule between group 2 and 3 was 0.012 (Fisher's exact test).

Table 2.
The clinical characteristics related with chemotherapy in group 1 and 2
Variables Group 1 (n=17) Group 2 (n=18) p-value
Follow-up of lung nodule     0.102
 Disappear 8 5  
 Decrease 4 11  
 Persistence 5 2  
hCG level before chemotherapy (IU/L) 9,763.0 (632.1–1,144,162.0) 1,764.0 (137.1–59,843.0) 0.320
FIGO prognosis score 2 (0–8) 2 (0–8) 0.833
First-line chemotherapy     0.603
 Single reagent 16 15  
 Multiple reagents 1 3  
Chemotherapy cycles 5 (3–10) 3 (1–6) 0.000
Failure of first-line chemotherapy 10 2 0.005
Occurrence of relapse 1 0
Occurrence of death 0 0

Values are presented as median (range) or number. FIGO, International Federation of Gynecology and Obstetrics; hCG, human chorionic gonadotrophin.

Table 3.
The response to chemotherapy for patients in group 1 and 2 by logistic regression analysis
Variables Chemotherapy cycles
Failure to first-line chemotherapy
OR (95% CI) p-value OR (95% CI) p-value
Age 1.03 (0.97–1.09) 0.349 1.01 (0.96–1.07) 0.644
Gestational age 1.01 (0.99–1.03) 0.205 0.99 (0.98–1.01) 0.455
Detected time 2.18 (0.51–9.33) 0.292 0.52 (0.11–2.45) 0.407
Size 0.60 (0.14–2.56) 0.494 0.56 (0.11–2.93) 0.491
Quantity 1.71 (0.37–7.85) 0.494 0.30 (0.06–1.42) 0.128
hCG level 1.00 (1.00–1.00) 0.057 1.00 (1.00–1.00) 0.722

CI, confidence interval; hCG, human chorionic gonadotrophin; OR, odds ratio.

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