评估达到正常人绒毛膜促性腺激素(hCG)水平后完全和部分磨牙妊娠后妊娠滋养细胞肿瘤的发生率,以指导循证随访建议。
MEDLINE,EMBASE,WebofScience,POPLINE,科克伦,和ClinicalTrials.gov从开始到2018年11月,使用“妊娠滋养细胞疾病,\"\"磨牙怀孕,“和”人类绒毛膜促性腺激素“主题。
筛选搜索结果以确定报告妊娠滋养细胞瘤形成的磨牙妊娠队列研究,至少6个月的预期正常hCG随访。
两位审稿人独立确定了要纳入的文章。使用标准化形式提取数据。对于荟萃分析,妊娠滋养细胞肿瘤的累积发病率,通过Agresti-Coull方法使用CI,并计算比较完全和部分摩尔的合并风险比(RR)。在19项符合条件的研究中,报告了足够的数据用于纳入主要荟萃分析,我们发现在两个完全葡萄胎后hCG水平正常后,妊娠滋养细胞肿瘤的发生率较低(64/18,357,0.35%,95%CI0.27-0.45%),和偏摩尔(5/14,864,0.03%,95%CI0.01-0.08%)。与磨牙部分妊娠相比,完全妊娠后发生妊娠滋养细胞瘤的风险明显更高(RR4.72,95%CI1.81-12.3,P=.002)。在完全葡萄胎后hCG水平正常后的妊娠滋养细胞肿瘤病例中,89.6%发生在从撤离到恢复正常的时间为56天或更长时间时,60.7%的患者被诊断为超过通常推荐的6个月监测间隔.敏感性分析,包括那些限制在低偏倚风险的研究,没有显着影响结果。我们发现,完全葡萄胎的妊娠滋养细胞肿瘤的总发生率为15.7%(1,354/8,611,95%CI15.0-16.5%),部分葡萄胎的总发生率为3.95%(221/5,593,95%CI3.47-4.50%)。
磨牙妊娠后hCG水平正常后,妊娠滋养细胞肿瘤的发展很少见。可以最大程度地减少对hCG随访的频率和持续时间的建议,以减轻患者的负担,并根据磨牙妊娠的类型和从子宫撤离到hCG正常化的时间间隔来了解。
PROSPERO,CRD42019116414。
To estimate the incidence of gestational trophoblastic neoplasia following complete and partial molar pregnancy after reaching normal human chorionic gonadotropin (hCG) levels to guide evidence-based follow-up recommendations.
MEDLINE, EMBASE, Web of Science, POPLINE, Cochrane, and ClinicalTrials.gov were searched from inception to November 2018, using the intersection of \"gestational trophoblastic disease,\" \"molar pregnancy,\" and \"human chorionic gonadotropin\" themes.
Search results were screened to identify cohort studies of molar pregnancy reporting gestational trophoblastic neoplasia development, with at least 6 months of intended normal hCG follow-up.
Two reviewers independently identified articles for inclusion. Data were extracted using a standardized form. For meta-analysis, cumulative incidence of gestational trophoblastic neoplasia, with CIs by the Agresti-Coull method, and pooled risk ratios (RRs) comparing complete and partial mole were calculated. Among the 19 eligible studies that reported adequate data for inclusion in the primary meta-analysis, we found low incidence of gestational trophoblastic neoplasia after normal hCG level following both complete mole (64/18,357, 0.35%, 95% CI 0.27-0.45%), and partial mole (5/14,864, 0.03%, 95% CI 0.01-0.08%). There was a significantly higher risk of gestational trophoblastic neoplasia after complete compared with partial molar pregnancy (RR 4.72, 95% CI 1.81-12.3, P=.002). Among gestational trophoblastic neoplasia cases after normal hCG level following complete mole, 89.6% occurred when the time from evacuation to normalization was 56 days or longer, and 60.7% were diagnosed beyond the commonly recommended 6-month surveillance interval. Sensitivity analyses, including those limiting to studies at low risk of bias, did not significantly affect results. We found an overall incidence of gestational trophoblastic neoplasia of 15.7% for complete mole (1,354/8,611, 95% CI 15.0-16.5%) and 3.95% for partial mole (221/5,593, 95% CI 3.47-4.50%).
Gestational trophoblastic neoplasia development after normal hCG level following molar pregnancy is rare. Recommendations for frequency and duration of hCG follow-up can be minimized to lessen burden on patients and informed by the type of molar pregnancy and time interval from uterine evacuation to hCG normalization.
PROSPERO, CRD42019116414.