Sixteen years experience in treatment and follow-up of patients with trophoblastic diseases.

From 1967 to 1982, 496 women with trophoblastic diseases received treatment and close follow-up thereafter at Kobe University Hospital. Of the 306 women who had hydatidiform mole evacuated at our hospital, invasive mole was followed by sequelae in 27 (9.1%), persistent trophoblastic disease (PTD) in 24 (8.1%), and choriocarcinoma in 2 (0.68%). Of the 496, 31 had choriocarcinoma with a survival rate of 51.6% as compared to a survival rate of 95.5% in the remaining patients with 115 invasive moles and with 97 PTDs. All 7 patients with non-metastatic choriocarcinoma were cured, while 14 (58.3%) out of 24 with metastatic choriocarcinoma died. The poor prognosis in choriocarcinoma resulted from metastases to multiple organs. Of the patients with malignant sequelae, 89.7% (218/243) had hydatidiform mole in the antecedent pregnancy, indicating that it is extremely important to follow-up patients closely after molar evacuation. The hCG excretion pattern is the most specific prognostic indicator. For routine hCG determination it is convenient to set up the following check points: 1,000 IU/1 at the 4th week, 100 IU/1 at the 6th week and 30 IU/1 at the 8th week following molar evacuation. There was no recurrence of invasive mole and PTD after the diagnosis of remission (less than 5–10 mlU/ml in sera for more than 3 weeks) confirmed by hCG-beta RIA. However, in one case of choriocarcinoma there was recurrence even after the diagnosis of remission determined by hCG-beta CTP assay (less than 0.5–1.1 IU/day in urine for more than 3 weeks). Initial chemotherapy given to patients with malignant sequelae should be considered “trial chemotherapy” instead of “primary chemotherapy”, the latter term being reserved for successful initial treatment.