Gestational Trophoblastic Disease Management

Gestational trophoblastic disease (GTD) comprises a spectrum of placental disorders ranging from premalignant hydatidiform moles to malignant gestational trophoblastic neoplasia (GTN), including invasive mole, choriocarcinoma, placental‐site trophoblastic tumour and epithelioid trophoblastic tumour. Early detection is achieved through transvaginal ultrasound and serial measurement of human chorionic gonadotropin (hCG), enabling prompt uterine evacuation of molar pregnancies and effective follow-up. Risk stratification utilises the International Federation of Gynecology and Obstetrics (FIGO) prognostic scoring system, guiding therapy towards single-agent chemotherapy for low-risk disease (score <7) and multiagent regimens for high-risk disease (score ≥7 or stage IV). Surgical options such as hysterectomy may be considered in women who have completed childbearing, particularly those over 40 years or with persistent disease. Multiagent chemotherapy protocols achieve cure rates exceeding 90% in high-risk GTN, often supplemented by surgery or radiotherapy for resistant or metastatic foci. Emerging strategies include immune checkpoint inhibition for chemoresistant cases and tailored approaches for rare presentations such as coexisting mole and live foetus. Long-term hCG surveillance remains essential to detect relapse and ensure durable remission, while multidisciplinary care optimises fertility preservation and quality of life.

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Gestational Trophoblastic Disease Management publication trend

The graph below shows the total number of articles in gestational trophoblastic disease management across all publications each year (not limited to Nature Index journals).

Technical terms

Hydatidiform mole: A benign proliferation of trophoblastic tissue characterised by vesicular chorionic villi and absent or abnormal foetal development.

Gestational trophoblastic neoplasia (GTN): The malignant subset of GTD, including invasive mole, choriocarcinoma and trophoblastic tumours, requiring chemotherapy.

FIGO prognostic scoring system: A numerical risk stratification tool combining tumour burden, metastasis sites and hCG levels to guide treatment intensity.

Human chorionic gonadotropin (hCG): A glycoprotein hormone secreted by trophoblasts, used as a biomarker for diagnosis, monitoring and detection of relapse.

Single-agent and multiagent chemotherapy: Treatment regimens using one drug (e.g. methotrexate) for low-risk GTN or combinations (e.g. EMA-CO) for high-risk disease.

PD-1/PD-L1 inhibitors: Immunotherapies targeting the programmed cell death protein 1 axis to enhance antitumour immunity in chemoresistant GTN.

References

1. Update on the diagnosis and management of gestational trophoblastic disease. International Journal of Gynecology & Obstetrics (2018).
2. Understanding and management of gestational trophoblastic disease. F1000Research (2019).
3. Diagnosis, classification and treatment of gestational trophoblastic neoplasia. Revista Brasileira de Ginecologia e Obstetrícia (2015).
4. Obstetric outcomes of twin pregnancies presenting with a complete hydatidiform mole and coexistent normal fetus: a systematic review and meta‐analysis. BJOG An International Journal of Obstetrics & Gynaecology (2020).
5. Current Evidence on Immunotherapy for Gestational Trophoblastic Neoplasia (GTN). Cancers (2022).
6. Total hysterectomy versus uterine evacuation for preventing post-molar gestational trophoblastic neoplasia in patients who are at least 40 years old: a systematic review and meta-analysis. BMC Cancer (2019).