Gestational Trophoblastic Disease: Diagnostic and Therapeutic Updates in Light of Recent Evidence: A Literature Review
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Hydatidiform Mole
3.2. Postmolar Gestational Trophoblastic Neoplasia
- -
- β-hCG plateau: at least four consecutive values (days 1, 7, 14, 21) with ≤10% change;
- -
- β-hCG increase: ≥10% increase over three consecutive values (days 1, 7, 14);
- -
- Persistence of β-hCG beyond 6 months after molar evacuation;
- -
- Positive histology for choriocarcinoma regardless of β-hCG trend;
- -
- Presence of metastatic disease (e.g., lung, brain, liver, GI) with positive β-hCG.
3.3. Gestational Trophoblastic Neoplasia
3.4. Management in GTD and New Approaches: Immunotherapy
- A stage based on the 2000 International Federation of Gynecology and Obstetrics (FIGO) staging system;
- A risk score based on the World Health Organization (WHO) modified prognostic scoring system.
3.5. Fertility and Reproductive Outcomes After GTD
3.6. Complete Familiar Hydatidiform Mole: A Particular Variant
3.7. Main Histological Features of GTD Variants
4. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Risk Factor | 0 | 1 | 2 | 4 |
---|---|---|---|---|
Age (years) | <40 | ≥40 | - | - |
Antecedent pregnancy | Mole | Abortion | Term | - |
Interval (months) | 4 | 4 to 6 | 7 to 12 | >12 |
Pretreatment serum hCG (mIU/mL) | <103 | 103 to 104 | 104 to 105 | >105 |
Largest tumor (including uterus) | <3 cm | 3 to 4 cm | ≥5 cm | - |
Site of metastases | Lung | Spleen, kidney | Gl tract | Brain, liver |
Number of metastases | - | 1 to 4 | 5 to 8 | >8 |
Prior failed chemotherapy | - | - | Single drug | ≥2 |
Study | Patient Number | Diagnosis | Treatment | Outcome |
---|---|---|---|---|
[39] | 150 | Low-risk post-molar GTN | MTX | a high β-hCG value one week after the first course of MTX predicts the need for additional courses or a change in therapy |
[43] | 35 studies | High-risk GTN | EMA-CO | complete response rate of 72–91% and overall survival of up to 94% in some cohorts |
[44] | 30 | High-risk GTN with metastases | EMA-CO | 93% survival and 67% permanent clinical response |
[64] | 4 | Multi-drug resistant GTN | Pembrolizumab | 3 complete remissions |
[66] | 20 | High-risk chemo-resistant GTN | Camrelizumab plus apatinib | 10 complete responses |
[65] | 4 | Multi-drug resistant GTN | Toripalimab | all achieved complete remission and the treatment was tolerable |
[67] | 7 | High-risk Multi-drug resistant GTN | Avelumab | 1 of 7 remissions |
[76] | 66 | Multidrug resistant disease | Camrelizumab –Sintilimab –Toripalimab – Pembrolzumab | 45 of 66 complete remissions |
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© 2025 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Gullo, G.; Satullo, M.; Conti, E.; Ganduscio, S.; Chitoran, E.; Kozinszky, Z.; Kowalcze, K.; Krysiak, R.; Billone, V.; Cucinella, G. Gestational Trophoblastic Disease: Diagnostic and Therapeutic Updates in Light of Recent Evidence: A Literature Review. Medicina 2025, 61, 1642. https://doi.org/10.3390/medicina61091642
Gullo G, Satullo M, Conti E, Ganduscio S, Chitoran E, Kozinszky Z, Kowalcze K, Krysiak R, Billone V, Cucinella G. Gestational Trophoblastic Disease: Diagnostic and Therapeutic Updates in Light of Recent Evidence: A Literature Review. Medicina. 2025; 61(9):1642. https://doi.org/10.3390/medicina61091642
Chicago/Turabian StyleGullo, Giuseppe, Marinì Satullo, Eleonora Conti, Silvia Ganduscio, Elena Chitoran, Zoltan Kozinszky, Karolina Kowalcze, Robert Krysiak, Valentina Billone, and Gaspare Cucinella. 2025. "Gestational Trophoblastic Disease: Diagnostic and Therapeutic Updates in Light of Recent Evidence: A Literature Review" Medicina 61, no. 9: 1642. https://doi.org/10.3390/medicina61091642
APA StyleGullo, G., Satullo, M., Conti, E., Ganduscio, S., Chitoran, E., Kozinszky, Z., Kowalcze, K., Krysiak, R., Billone, V., & Cucinella, G. (2025). Gestational Trophoblastic Disease: Diagnostic and Therapeutic Updates in Light of Recent Evidence: A Literature Review. Medicina, 61(9), 1642. https://doi.org/10.3390/medicina61091642