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Previous issue date: 2016-02-29 / Apesar de 10 a 34% das pacientes com gravidez molar serem adolescentes,
a influencia da idade precoce na apresentação clínica e no risco de desenvolvimento de
neoplasia trofoblástica gestacional pós-molar (GTN) ainda é incerto. Objetivos.
Comparar a apresentação clínica da mola hidatiforme completa (MHC) e os fatores de
risco associados com o desenvolvimento de NTG entre adolescentes da América do
Norte e América do Sul. Métodos. Estudo de coorte não concorrente incluindo
adolescentes (< 20 anos) com MHC tratadas em centro da América do Norte (New
England Trophoblastic Disease Center, Universidade de Harvard, Estados Unidos) entre
1973-2009, e centros da América do Sul (Centro de Doença Trofoblástica de Botucatu –
Universidade Estadual Paulista, Unesp, Brazil; Unidade Trofoblástica da Universidade
Central da Venezuela e Maternidad Concepción Palácios de Caracas, Venezuela), entre
1990-2009. Dados clínicos das pacientes coletados foram idade, idade gestacional ao
diagnóstico, tamanho do útero, hCG pré-esvaziamento, presença de cistos
tecaluteínicos, anemia, sangramento vaginal, pré-eclampsia e hiperemese. As
participantes do estudo foram alocadas em dois grupos de adolescentes: América do
Norte (AN, n = 195) e América do Sul (AS, n = 231). Resultados. Na apresentação,
anemia (AS = 48% vs AN = 15%; p <0,001), hiperemese (AS = 14% vs AN = 6%; p =
0,003), e hCG sérico elevado (AS = 229591 mUI / mL vs AN = 14000 mUI / mL; p
<0,001) foram mais frequentes na AS que AN. Na AS, pré-eclâmpsia [AS: OR = 4,33
(1,37-13,65) vs AN: OR = 0,34 (0,04-2,86)], tamanho do útero> idade gestacional [AS:
OR = 2,50 (1,26-4,94) vs AN: OR = 1,69 ( 0,87-3,26)]; e cistos> 6 cm [AS: OR = 2,25
(0,80-6,33) vs AN: OR = 1,43 (0,57-3,56)] tiveram maior impacto sobre o risco de
desenvolver NTG pós-molar. Em contraste, apenas sangramento vaginal. [AS: OR =
1,37 (0,64-2,91) vs AN: OR = 2,79 (1,10-7, 06] influenciou risco de NTG na AN.
Conclusões. Comparado à AN, MHC em adolescentes da AS mostraram complicações
médicas mais frequentemente e fatores clínicos com maior impacto sobre o risco de
desenvolvimento de NTG. / Although 10-34% of patients with molar pregnancy are adolescent, the
influence of young age on the clinical presentation and risk of developing post-molar
gestational trophoblastic neoplasia (GTN) is still unclear. Objectives. To compare
complete hydatidiform mole (CHM) clinical presentation and risk factors associated
with developing GTN between North American adolescents and South American
counterparts. Methods. Non-concurrent cohort study including adolescents ( 20 years)
with CHM referred to centers in North America (New England Trophoblastic Disease
Center, Harvard University,USA) between 1973-2009, and South America (Botucatu
Trophoblastic Disease Center-São Paulo State University-Unesp, Brazil; Trophoblastic
Unit of Central University of Venezuela and Maternidad Concepcion Palacios of
Caracas, Venezuela) between 1990-2009. Patient clinical data collected included age,
gestational age at diagnosis, uterine size, pre-evacuation hCG, presence of theca lutein
cysts, anemia, vaginal bleeding, preeclampsia, and hyperemesis. Study participants were
allocated into two groups of adolescents: North American (NA,n=195) and South
American (SA,n=231). Results. At presentation, anemia (SA=48% vs
NA=15%;p<0.001), hyperemesis (SA=14% vs NA=6%;p=0.003), and elevated serum
hCG (SA=229591 mUI/mL vs NA=14000 mUI/mL ; p<0.001) were more frequent in
SA than in NA. In SA, preeclampsia (SA:OR=4.33(1.37-13.65) vs NA:OR=0.34(0.04-
2.86), uterine size>gestational age (SA:OR= 2.50(1.26-4.94) vs NA: OR=1.69(0.87-
3.26); and cysts > 6cm (SA: OR= 2.25(0.80-6.33) vs NA:OR=1.43(0.57-3.56) had
greater impact on the risk of developing post-molar GTN. In contrast, only vaginal
bleeding (SA:OR=1.37(0.64-2.91) vs NA: OR=2.79(1,10-7, 06) influenced GTN risk in
NA. Conclusions. Compared to NA, CHM among SA adolescents showed medical
complications more frequently, and clinical features with greater impact on risk of GTN
development.
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unesp.br:11449/138162 |
| Date | 29 February 2016 |
| Creators | Soares, Renan Rocha [UNESP] |
| Contributors | Universidade Estadual Paulista (UNESP), Maestá, Izildinha [UNESP], Cortés-Charry, Rafael, Berkowitz, Ross |
| Publisher | Universidade Estadual Paulista (UNESP) |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | Portuguese |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Source | reponame:Repositório Institucional da UNESP, instname:Universidade Estadual Paulista, instacron:UNESP |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 600 |
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