The Role Of Hysterectomy In Gestational Trophoblastic Disease

Abstract

Objective: To evaluate indications and role of hysterectomy in women presenting with gestational trophoblastic disease. Material and Methods: 320 women attended to Women’s Health Research and Education Hospital Oncology Department with a diagnosis of gestational trophoblastic disease during the period 1996-2004 were screened. Thirty patients had hysterectomy and chemotherapy regarded as study grup (group I) and the patients followed only with chemotherapy without hysterectomy according to the treatment protocol in our hospital were regarded as control group (group II). The pretreatment risk score , remission period after hysterectomy, the amount of given chemotherapy were evaluated from the reports retrospectively. Chi-square and Mann-Whitney U tests were used for statistical analysis. Results: Significant difference was observed between two groups according to the age. The median age in group I was 23.5 y(15-50), in group II was 45y(19-58)(p<0.001). According to the pretreatment risk score , given chemotherapy amount, remission period(month) in group I respectively 4.5, 1,1. In group II respectively 3,4.5,3 (p<0.001). Hysterectomy indications were; women who completed fertility, patient choice, heavy vaginal bleeding, chemoresistant disease, plasental site tumor pathology limited to uterus. Post molar gestational trophoblastic disease after dilatation and curettage was 18.7%. After hysterectomy in the following period (1-9 years), there were no invasive or metastatic disease detected. Discussion: Chemotherapy amount that were given to get remission and remission period in the patients with low-risk potential and who had chemoresistant disease and plasental site tumor pathology limited to the uterus were lower. Hysterectomy can be an option in these patients with completed fertility period.

Keywords

• Gestational Trophoblastic Disease,Hysterectomy

Gestasyonel Trofoblastik Hastalıklarda Histerektominin Rolü

Abstract

Amaç: Gestasyonel trofoblastik hastalık tanısı ile başvuran hastalarda histerektomi endikasyonları ve histerektominin hastalığın takibindeki rolünü araştırmayı planladık. Materyal Metot: Kadın Hastalıkları ve Doğum Eğitim ve Araştırma Hastanesi’ne 1996-2004 yılları arasında gestasyonel trofoblasik hastalık tanısı ile başvuran 320 hasta retrospektif olarak tarandı. Çalışmaya takibinde kemoterapi ve histerektomi uygulanan 30 hastamız çalışma grubu olarak (grup I), yine takibinde sadece kemoterapi uygulanan 68 hastamız kontrol grubu olarak oluşturuldu ( grupII). Hastaların patolojik tanıları, yaşları , tedavi öncesi ve sonrası uygulanan tetkikler , histerektomi nedenleri, remisyon süreleri ve aldıkları tedaviler gibi bilgiler dosyalardan taranarak incelendi. Ki-kare ve Mann Whitney U testleri istatistik analiz için kullanıldı. Sonuçlar: Her iki grupta yaşlar arasında istatistiksel fark saptandı. Grup I’ in ortalama yaşı 23.5 (15-50) saptanırken, grup II‘nin ortalam yaşı 45(19-58) idi (p<0.001). Tedavi öncesi risk skorları, verilen kemoterapi kür sayısı, ve remisyon periotlarına bakıldığında ayrı ayrı Grup I ‘de 4.5, 1, 1 bulunurken, Grup II ‘de 3,4.5, 3 olarak saptanmış ve istatistik fark saptanmıştır(p<0.001). Histerektomi endikasyonları fertilitesini tamamlamış hastalar, hastanın isteği, yoğun vaginal kanama , kemorezistan hastalık, uterusa sınırlı plasental bölge tümörü olarak sınıflandırılmıştır. Dilatasyon ve küretaj sonrası post molar gestasyonal trofoblastik hastalık gelişme insidansı %18.7 olarak bulunmuştur, ancak histerektomi sonrası takip sürelerinde (1-9 yıl) herhangi bir invasive mol veya metastatik hastalık görülmemiştir. Tartışma: Histerektomi sonrası düşük riskli gestasyonel trofoblastik neoplazisi olup uterusa sınırlı plasental bölge tümorü ve ve kemorezistan olan hastaların kemoterapi ihtiyacı ve remisyon sürelerinin daha düşük olduğu saptanmıştır. Fertilite isteği olmayan bu grup hastalarda histerektomi önerilebilir.

Keywords

• Gestasyonel trofoblastik hastalıklar,histerektomi

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