Multivariate Analysis of Risk Factors for Persistent Gestational Trophoblastic Neoplasia in Patients with Hydatidiform Mole

Author(s): Sayada Fatema Khatun, Jannatul Ferdous, Shirin Akter Begum, Salma Akter Munmun, Rowson Ara, Khairun Nahar, Nazma Akter, AKM Farhad Hossain

Introduction: Gestational trophoblastic disease (GTD) is a group of neoplastic disorders that arise from placental trophoblast cells following abnormal fertilization. Persistent Gestational Trophoblastic Neoplasia (PGTN) is a severe complication that can occur following a hydatidiform mole, requiring the early identification of high-risk patients. This study aimed to analyze the risk factors associated with PGTN in patients with hydatidiform moles using multivariate analysis.

Methods: A retrospective analysis was conducted on 50 patients diagnosed with hydatidiform moles, categorized into GTN-positive (n=7) and GTN-negative (n=43) groups at the Gynecological Oncology Outpatient Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2021 to December 2021.

Result: Age and BMI were significantly associated with GTN positivity (p=0.024 and p=0.012, respectively). GTN-positive patients were predominantly under 20 years old (71.4%) and underweight (100%). A history of abortion was absent in all GTN-positive cases, while the presence of grape-like vesicles (100%), larger vesicle size (>2 cm), and a history of molar pregnancy (71.4%) were significantly more common in the GTN-positive group (p<0.05). Ultrasound findings showed a higher prevalence of cystic vesicles and theca lutein cysts >6 cm in GTN-positive patients (p<0.05). Initial post-evacuation β-hCG levels were significantly higher in GTN-positive cases (p<0.05), with levels in weeks 5 to 8 demonstrating the strongest predictive power for GTN development (AUC = 99.7%). Multivariate analysis identified younger age as a significant independent risk factor for PGTN (OR: 1.17, 95% CI: 1.02–16.3, p<0.05), while the history of molar pregnancy, thyrotoxic features, and uterine size were not significantly associated.

Conclusion: The findings show that younger age, low BMI, larger vesicle size, high initial β-hCG levels, and prolonged elevated β-hCG levels (weeks 5–8) were significant predictors of GTN development. History of a mole in a previous pregnancy, thyrotoxic features, and uterine size per abdomen were also risk factors but were not significantly associated with PGTN. Close monitoring of these risk factors can aid in the early identification and management of high-risk patients to prevent progression to PGTN.