TỶ SUẤT TÂN SINH NGUYÊN BÀO NUÔI VÀ CÁC YẾU TỐ LIÊN QUAN TRÊN BỆNH NHÂN THAI TRỨNG LỚN TUỔI TẠI BỆNH VIỆN TỪ DŨ

Abstract

Background: Hydatidiform mole (HM) in elderly patient has a high-risk developing post molar gestational trophoblastic neoplasia (GTN). Uterine evacuation is main method to treat HM. There are some prophylactic methods, they are prophylactic hysterectomy, chemotherapy or combining hysterectomy and chemotherapy. The purpose of utilizing these methods is to decrease risk of progressing GTN. The acknowledge of effectively prophylactic methods and rate of GTN in women older than 40 years of age which is useful for consulting and selecting suitable method of treatment. Objective: The study aimed to determine the GTN rate and asscociated factors associated of HM in elderly patients. Methods: This is a retrospective cohort study with 372 patients older than 40 years-old who were diagnosed HM based on histology by uterine evacuation at TuDu hospital from 01/2016 to 03/2019. Results: Followed-up by 2 years, 123 patients developed GTN, the incidence of GTN was 33.06% (95%CI:28.3-38.1). The median time progressed GTN which was 4.15±2.93 weeks. The highest rate of GTN was recognized at the second and third week after evacuation. Applying multivariate model, the rate of GTN was significantly higher in group older than 46 years of age than group 40-45 years-old (HR=1.63, 95%CI:1.09-2.44) and in vaginal bleeding group than none bleeding group (HR=1.85, 95%CI:1.16-2.96). Prophylactic hysterectomy or combined with chemotherapy reducing risk of progressing to GTN more than group which was not intervened (HR=0.16, 95%CI:0.09-0.30) and (HR=0.09, 95%CI=0.04-0.21) respectively. Prophylactic chemotherapy was not impact on diminishing risk of GTN (HR=0.74, 95%CI:0.21-2.62). Conclusions: The rate of post-molar GTN in elderly patient was 33.06%. Prophylactic hysterectomy and chemotherapy was effective treatment and helpful to decrease risk of GTN.