Document Detail


Hyperglycosylated hCG in the management of quiescent and chemorefractory gestational trophoblastic diseases.
MedLine Citation:
PMID:  19822356     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The literature shows that hyperglycosylated hCG is the invasion stimulus in malignant gestational trophoblastic diseases. The USA hCG Reference Service has characterized 2 gestational trophoblastic disease conditions marked by low proportion of hyperglycosylated hCG. These are quiescent gestational trophoblastic disease, defined as inactive or benign invasive disease, and minimally invasive gestational trophoblastic disease, defined as slow growing or chemorefractory disease with hCG increasing very slowly (doubling rate 2-6 weeks). Here we examine the USA hCG Reference Service experience with both diseases. METHODS: Patient were referred to the USA hCG Reference Service, 133 cases shown to have quiescent gestational trophoblastic disease, 35 cases with aggressive and 30 with minimally invasive gestational trophoblastic disease. RESULTS: Quiescent or inactive gestational trophoblastic disease was demonstrated in 133 women. In 127 of these cases, no hyperglycosylated hCG was detected, and in 6 cases 4-27% hyperglycosylated hCG was detected. This is quiescent or inactive disease. Only 1 of 35 cases with aggressive gestational trophoblastic disease (>40% hyperglycosylated hCG) was chemorefractory. In contrast, 30 of 30 minimally invasive cases (<40% hyperglycosylated hCG) were chemorefractory. In chemorefractory cases hyperglycosylated hCG ranged from <1% to 39% of total hCG. The USA hCG Reference Service showed that proportions hyperglycosylated hCG significantly increases as total hCG rises. They recommended in minimally invasive cases to wait to hCG was >3000 IU/L before commencing chemotherapy. This was successful in 10 of 10 minimally invasive cases. DISCUSSION: Measurement of hyperglycosylated hCG or invasiveness is a critical step in management of invasive gestational trophoblastic disease. Quiescent of inactive gestational trophoblastic disease requires no therapy. Minimally invasive disease in chemorefractory. The USA hCG Reference Service experience suggests waiting until hCG exceeds 3000 IU/L before commencing any chemotherapy.
Authors:
Laurence A Cole; Carolyn Y Muller
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Publication Detail:
Type:  Journal Article     Date:  2009-10-12
Journal Detail:
Title:  Gynecologic oncology     Volume:  116     ISSN:  1095-6859     ISO Abbreviation:  Gynecol. Oncol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-07     Completed Date:  2009-12-11     Revised Date:  2010-05-14    
Medline Journal Info:
Nlm Unique ID:  0365304     Medline TA:  Gynecol Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3-9     Citation Subset:  IM    
Affiliation:
USA hCG Reference Service, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87109, USA. larry@hcglab.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Chorionic Gonadotropin / blood,  metabolism*,  urine
Drug Resistance, Neoplasm
Female
Gestational Trophoblastic Neoplasms / drug therapy*,  metabolism*,  pathology
Glycosylation
Humans
Middle Aged
Pregnancy
Reference Values
Young Adult
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin
Comments/Corrections
Comment In:
Gynecol Oncol. 2010 Jun;117(3):505-6; author reply 506-7   [PMID:  20181383 ]
Gynecol Oncol. 2010 Jun;117(3):505   [PMID:  20144843 ]

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