Objectives: To evaluate the potential associations of the type of complete hydatidiform mole (CHM) initial treatment (hysterectomy or uterine evacuation) with GTN development, need for chemotherapy, and treatment outcome in women aged ≥ 40 years.Methods: This multicentric retrospective cohort study included women ≥ 40 years with CHM, initially treated between 1990 and 2018, at four different centers. Data collected included patient demographics and clinical characteristics. The outcome variables were post-CHM GTN development, need for chemotherapy for hCG normalization, surgical complications, and time to remission. Univariate and multivariate analyses were performed using chi-square, Mann–Whitney, Fisher’s exact tests, and Poisson regression.Results: 275 women with CHM aged ≥ 40 years were included in the analysis. Median patient age was significantly higher among hysterectomy patients (47 × 44 years,p= 0.01). Multivariate analysis showed that compared with uterine evacuation (244/275, 89%), hysterectomy (31/275, 11%) was associated with an 83% lower risk of GTN [RR = 0.17 95% CI = (0.04–0.71);p= 0.015] and a 92% lower risk of requiring chemotherapy [RR: 0.08 (0.01–0.64),p= 0.016]. Median time to hCG normalization did not statistically differ between treatments. No significant differences were observed between hysterectomy and uterine evacuation in terms of FIGO staging (p= 0.221) or prognostic risk score (p= 0.576). Resistance to first-line chemotherapy (17/72; 23.6%) and relapse (3/72; 4.1%) were observed only in patients undergoing initial uterine evacuation. Hysterectomy complications occurred in 45.1% (14) of the patients.Conclusions: CHM initial treatment with hysterectomy was associated with a lower risk for GTN occurrence and need for chemotherapy in women aged 40 years or older. However, shared decision-making about surgery should be tailored to each patient and their risk factors and preferences. Further, larger controlled studies are required to support our findings.
目的：评估40岁及以上女性完全性葡萄胎（CHM）初始治疗方式（子宫切除术或清宫术）与妊娠滋养细胞肿瘤（GTN）发生、化疗需求及治疗结局的潜在关联。 方法：本项多中心回顾性队列研究纳入1990年至2018年间在四个不同中心接受初始治疗的40岁及以上CHM女性患者。收集的数据包括患者人口统计学特征和临床特征。结局变量包括CHM后GTN发生情况、为达到hCG正常化所需的化疗、手术并发症及缓解时间。采用卡方检验、Mann-Whitney检验、Fisher精确检验和泊松回归进行单变量和多变量分析。 结果：共275名40岁及以上CHM女性纳入分析。子宫切除术患者的中位年龄显著更高（47岁 vs 44岁，p=0.01）。多变量分析显示，与清宫术（244/275，89%）相比，子宫切除术（31/275，11%）可使GTN发生风险降低83%[RR=0.17，95% CI=(0.04–0.71)；p=0.015]，化疗需求风险降低92%[RR=0.08（0.01–0.64），p=0.016]。两组达到hCG正常化的中位时间无统计学差异。在FIGO分期（p=0.221）和预后风险评分（p=0.576）方面，子宫切除术与清宫术组间未观察到显著差异。一线化疗耐药（17/72；23.6%）和复发（3/72；4.1%）仅见于初始接受清宫术的患者。子宫切除术并发症发生率为45.1%（14例）。 结论：对于40岁及以上女性，采用子宫切除术作为CHM初始治疗可降低GTN发生风险和化疗需求。然而，关于手术的临床决策应结合患者个体情况、风险因素及个人意愿进行综合考量。未来需要更大规模的对照研究以验证本结论。
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