PURPOSE: to study the frequency of recurrent gestational trophoblastic neoplasm and to analyze whether the features and the outcome of the repetitive disease lead to a higher risk of invasion or of malignization and the need for more courses of chemotherapy and more aggressive regimens. METHODS: twenty-nine patients with recurrent hydatidiform mole were followed up at the Santa Casa da Misericórdia Trophoblastic Disease Center (Rio de Janeiro, Brazil) between 1960 and 2001, showing an incidence of 1.28% (29/2262). The medical charts were examined to determine the patient's age, number of pregnancies, parity, clinical presentation and chemotherapy. A total of fifty-eight trophoblastic neoplasm episodes occurred in these 29 patients and all were reviewed regarding their pathology. Statistical data were determined by the chi2 test with Yates correction and analysis was performed using Epi-Info software for Windows 2000. RESULTS: invasive mole or choriocarcinoma occurred at the first event of hydatidiform mole in only one patient (1/29 - 3.44%), whereas invasion or malignization occurred in the second event in seven patients (7/29 - 24,13%) [OR: 8.9; CI 95%: 1.5 - 41; p<0.05]. CONCLUSION: recurrent molar pregnancy was associated with histological worsening and an increase in the incidence of proliferative trophoblastic sequelae in the consecutive episodes of hydatidiform mole, more frequent and aggressive chemotherapy being necessary.
Gestational trophoblastic neoplasia; Molar pregnancy; Chemotherapy
