Correlation of Post-Evacuation Serum β-hCG Levels with Persistent Gestational Trophoblastic Neoplasia: A Tertiary Care Experience

Background: Gestational trophoblastic disease (GTD) includes various abnormal cell growths from the placental trophoblast, such as hydatidiform mole, invasive mole, choriocarcinoma, and placental site trophoblastic tumor (PSTT). This study aimed to determine if post-evacuation serum hCG levels and their ratio during the first two weeks could predict persistent gestational trophoblastic neoplasia (GTN) in complete molar pregnancies. Aim of the study: The aim of the study was to evaluate the relationship between post-evacuation serum β-hCG levels and the occurrence of persistent gestational trophoblastic neoplasia in patients at a tertiary care center. Methods: This cross-sectional study was conducted at the Outpatient Department of Gynecological Oncology, BSMMU, Dhaka, in 2021, involving 50 patients with histopathologically confirmed molar pregnancy. Post-evacuation β-hCG levels were monitored to assess the risk of persistent gestational trophoblastic neoplasia (PGTN). Data were analyzed using SPSS version 20 with t-tests, chi-square tests, ROC curves, and logistic regression, setting p<0.05 as significant. Results: GTN-positive patients were younger, had lower incomes, and were underweight. They showed a higher prevalence of grape-like vesicle expulsion, thyrotoxic symptoms, prior molar pregnancies, and family history of molar pregnancy. β-hCG levels >100,000 mIU/mL were found in all GTN-positive cases. Log-transformed β-hCG levels from weeks 5 to 8 were higher in GTN-positive cases, with week 8 β-hCG providing 97.7% sensitivity, 100% specificity, and an AUC of 0.997 for GTN prediction. Conclusion: Elevated post-evacuation β-hCG levels and specific clinical factors are strong predictors of persistent gestational trophoblastic neoplasia in hydatidiform mole, highlighting the importance of early detection.