Monitoring complete hydatidiform molar pregnancies after normalisation of human chorionic gonadotrophin: national retrospective population study
Bibliographic record
Abstract
Objective To provide evidence for a reduced surveillance protocol to detect gestational trophoblastic neoplasia after normalisation of human chorionic gonadotrophin (hCG) levels following uterine evacuation of a complete hydatidiform mole. Design National retrospective population study Setting Two UK Trophoblastic Disease Treatment Centres (Sheffield and London), 1 January 1980 to 30 November 2020. Participants 17 424 patients with hCG normalisation after evacuation of their complete hydatidiform mole were included. Complete hydatidiform moles were verified by centralised pathological review. Patients were excluded if lost to follow-up or required treatment before normalisation of hCG levels. Main outcome measures Incidence and clinical presentation of gestational trophoblastic neoplasia after normalisation of hCG levels following uterine evacuation of a complete hydatidiform mole. Results Of 17 424 patients whose hCG normalised after complete hydatidiform mole evacuation, 99.8% (n=17 393 of 17 424) did not subsequently develop gestational trophoblastic neoplasia. The overall risk of gestational trophoblastic neoplasia after previous normalisation of hCG levels was 0.2% (n=31 of 17 424 patients). The risk of developing gestational trophoblastic neoplasia after uterine evacuation was substantially lower if hCG levels returned to normal in <56 days rather than ≥56 days (posterior medians 0.06%, 95% credible interval 0.01% to 0.14% v 0.22%, 0.15% to 0.31%), with a posterior relative risk of 0.25 (0.06 to 0.72). Most patients who developed gestational trophoblastic neoplasia (71.0%, n=22 of 31) had received a diagnosis after the current six month surveillance protocol. The cumulative risk of developing gestational trophoblastic neoplasia in patients whose hCG levels normalised early increased minimally with time. If a patient had normal hCG levels in <56 days, a clinically relevant time point, the risk of developing gestational trophoblastic neoplasia was small (0.04%, about 1 in 2619 patients) at 39 months after normalisation. The equivalent risk for a patient who had normal hCG levels in ≥56 days was 0.16% (about 1 in 642 patients). All 31 women who developed gestational trophoblastic neoplasia achieved sustained remission after subsequent treatment. Conclusions The findings of the study indicate that surveillance protocols could safely change to one confirmatory normal hCG value for patients whose hCG levels return to normal in <56 days of evacuation of a complete hydatidiform mole. Patients whose hCG levels return to normal in ≥56 days should be counselled on the remaining risk of gestational trophoblastic neoplasia over time to help decide the length of subsequent follow-up.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".