Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
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DOI：
10.1093/annonc/mdt345
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发表时间：
2013-10-01
影响因子：
50.5
通讯作者：
Sessa, C.
中科院分区：
文献类型：
--
作者：
Seckl, M. J.;Sebire, N. J.;Sessa, C.
妊娠滋养细胞疾病（GTD）包括一系列疾病，从完全性（CHM）和部分性（PHM）葡萄胎的癌前状态到恶性侵袭性葡萄胎、绒毛膜癌（CC）和非常罕见的胎盘部位滋养细胞肿瘤/上皮样滋养细胞肿瘤（PSTT/ETT）。这种疾病的恶性形式也统称为妊娠滋养细胞肿瘤或肿瘤（GTN）。在英国，所有GTD病例均在全国范围内登记，并进行中央病理审查。CHM和PHM的发病率估计分别为1-3：1000和3：1000，其他西方国家报告了类似的数据[1]。GTD在亚洲似乎比在北美或欧洲更常见。这可能是因为医院和人群数据之间的差异，中央病理审查的可用性，或可能反映饮食和遗传影响。臼齿妊娠的风险增加见于年龄很小的人（< 16岁），但与高龄产妇（> 45岁）最相关[1]。在葡萄胎妊娠后，进一步CHM或PHM的风险增加到10.1%。在两颗葡萄胎妊娠后，第三颗葡萄胎的风险为15%-20%，并且不会因更换伴侣而降低。CC和PSTT的频率不太清楚，因为它们可以在任何类型的妊娠后发生。CC在约1：50 000分娩后发展，而最近的数据表明PSTT占英国GTD病例的0.2%[2]。GTN的风险也可能与激素因素有关，因为12岁后初潮、月经量少和先前使用口服避孕药的女性风险增加。此外，如果在人绒毛膜促性腺激素（hCG）仍然升高时开始使用口服避孕药，则在一些但不是所有系列中，葡萄胎（HM）后的恶性肿瘤风险与口服避孕药有关[1]。这种激素对于GTD的诊断、管理和后续监测至关重要，关于hCG及其测量的详细信息见方框1。
Gestational trophoblastic disease (GTD) comprises a spectrum of disorders from the pre-malignant conditions of complete (CHM) and partial (PHM) hydatidiform moles through to the malignant invasive mole, choriocarcinoma (CC) and very rare placental site trophoblastic tumour/epithelioid trophoblastic tumour (PSTT/ETT). The malignant forms of the disease are also collectively known as gestational trophoblastic tumours or neoplasia (GTN). In the UK, all GTD cases are nationally registered, with central pathology review. The incidence is estimated at 1-3: 1000 pregnancies for CHM and 3: 1000 pregnancies for PHM, respectively, with other western countries reporting similar data [1]. GTD appears to be more frequent in Asia than in North America or Europe. This may be because of discrepancies between hospital-and population-based data, availability of central pathological review or may reflect dietary and genetic influences. An increased risk of molar pregnancy is seen in the very young (< 16 years), but is most associated with advanced maternal age (> 45 years)[1]. Following a molar pregnancy, the risk of a further CHM or PHM increases to∼ 1%. After two molar gestations, the risk of a third mole is 15%–20% and is not decreased by changing partners.The frequency of CC and PSTT is less clear, since these can arise after any type of pregnancy. CC develops after around 1: 50 000 deliveries, while recent data suggest that PSTT represents 0.2% of UK GTD cases [2]. GTN risk may also relate to hormonal factors since women with menarche after 12 years of age, light menstrual flow and prior use of oral contraceptives are at increased risk. Additionally, the subsequent risk of malignancy following a hydatidiform mole (HM) has been linked in some but not all series to oral contraceptives, if started while the human chorionic gonadotrophin (hCG) is still elevated [1]. This hormone is essential for the diagnosis, management and subsequent surveillance of GTD and details regarding hCG and its measurement are provided in Box 1.