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

J Gynecol Oncol 2019;30(2):e16.

Published online: 4 March 2019

DOI: https://doi.org/10.3802/jgo.2019.30.e16

The management of hydatidiform mole with lung nodule: a retrospective analysis in 53 patients

Xiao Li1, 2, Yaping Xu2, 3, Yuanyuan Liu1, 2, Xiaodong Cheng1, 2, Xinyu Wang1, 2, Weiguo Lu1, 2, 4, Xing Xie1, 2

1Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China

2Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China

3Obstetrics and Gynecology, Hangzhou Red Cross Hospital, Hangzhou, China

4Center for Uterine Cancer Diagnosis & Therapy Research of Zhejiang Province, Hangzhou, China

Correspondence to Xiao Li Women's Reproductive Health Laboratory of Zhejiang Province, Women's Hospital, Zhejiang University School of Medicine, No. 1 Xueshi Road, Hangzhou 310006, China. E-mail: 5198008@zju.edu.cn

Conflict of Interest No potential conflict of interest relevant to this article was reported.

Received 31 August 2018       Revised 7 October 2018       Accepted 23 October 2018

Copyright © 2019 Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

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

Methods

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.

Results

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).

Conclusion

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.

Keywords: Hydatidiform Mole, Pulmonary Nodule, Chemotherapy, Gestational Trophoblastic Neoplasia, Chorionic Gonadotrophin

References

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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.
jgo-30-e16f1.tif
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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