The role of hCG in trophoblast disease diagnosis and management

Produced predominantly by the syncytiotrophoblast cells, hCG is a glycosylated heterodimer protein consisting of the alpha and beta units held together non-covalently. However, in malignant disease a number of variants can occur including hyperglycosylated hCG, nicked hCG, hCG missing the beta subunit C terminal peptide and the free beta subunit. With the exception of a few atypical cases of PSTT, hCG is constitutively expressed by malignant trophoblast cells. The measurement of hCG allows an estimation of the tumour bulk, forms an important part of the assessment of the patient's disease risk and provides a simple method to follow the response to treatment. The hCG level can be measured by a variety of immunoas-says but at present there is no internationally standardized assay and the various commercially available kits used in different hospitals can vary in their ability to detect different portions of partially degraded hCG molecules and so can give divergent results and occasional false negatives [6]. Fortunately the hCG assay used at CXH has been demonstrated to recognize all forms of hCG and can be used as reference test in difficult cases.

In the absence of tumour hCG production the serum half-life of hCG is 24-36 h; however, in the clinical situation total hCG levels characteristically show slower falls

Table 15.2 FIGO scoring system

Scores

0

1

2

4

Age

<40

>40

-

-

Antecedent pregnancy

Mole

Abortion

Term

-

Months from index pregnancy

<4

4-รณ

7-13

>13

Pre-treatment hCG

<1000

1000-10,000

1000-100,000

>100,000

Largest tumour size

<3 cm

3-5 cm

>5 cm

-

Site of mets

Lung

Spleen, kidney

Gastro-intestinal

Brain, liver

Number of mets

-

1-4

5-8

>8

Previous chemotherapy

-

-

Single agent

Two or more drugs

as the tumour cells continue to produce some hCG as their number decreases with treatment.

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