Surveillance After Human Chorionic Gonadotropin Normalization Following Molar Pregnancy: A Systematic Review and Meta-Analysis

Objective: The aim of this systematic review and meta-analysis was to estimate the incidence and time to diagnosis of postmolar gestational trophoblastic neoplasia (GTN) following uterine evacuation and normalization of human chorionic gonadotropin (hCG).Materials and Methods: Databases, including PubMed Medline,(R) Ovid Medline,(R) Cumulative Index to Nursing and Allied Health Literature, and Embase, were searched from inception to July 23, 2019, for studies of patients with molar pregnancies who were surveilled until normalization of hCG with at least 6 months of intended follow-up data. Meta-analyses were performed on subgroups of hCG normalization before and after 56 days as well as partial versus complete molar pregnancies.Results: Of 816 studies screened, 25 cohort studies encompassing 40,513 cases of hCG normalization following molar pregnancy were identified. The overall incidence of postmolar gestational trophoblastic neoplasia (pGTN) after spontaneous normalization of hCG was 0%-1.5%. Sixty-one percent of pGTN cases following hCG normalization were diagnosed beyond 6 months from normalization. The risk of neoplasia in women who had normalization before 56 days was significantly lower than women who had normalization after 56 days with a pooled odds ratio of 0.28 (95% confidence interval: 0.12, 0.66; p < 0.001).Conclusions: pGTN has a low incidence after spontaneous normalization of hCG When this neoplasia does occur, it often presents well beyond the standard recommended surveillance timeperiods. (J GYNECOLOGIC SURG 20XX:000)