Serum β-hCG Trends and Their Clinical Significance in Persistent Gestational Trophoblastic Neoplasia

Open Access

Abstract

Background: Persistent gestational trophoblastic neoplasia (PGTN) is characterized by abnormal trophoblastic proliferation with persistently elevated or abnormal serum β-hCG levels. Serial β-hCG monitoring is crucial for assessing disease activity, treatment response, and prognosis. Aim of the study: To evaluate serum β-hCG trends and determine their clinical significance in predicting persistence, treatment response, and prognosis in PGTN patients. Methods & Materials: This cross-sectional study was conducted in the Department of Gynecological Oncology, BSMMU, Bangladesh (January-December 2021). A total of 50 PGTN patients were included. Serial serum β-hCG levels, clinical characteristics, FIGO risk scores, metastatic status, and treatment outcomes were analyzed using SPSS version 20. Chi-square tests and logistic regression were applied. Result: All patients (100%) presented with initial β-hCG >10⁵ mIU/mL. Declining β-hCG trends were observed in 88%, plateau in 6%, and rising in 6%. Complete remission occurred in 100% of patients with declining trends, while persistent disease (66.67%) and recurrence (33.33%) were seen in plateau/rising groups (p=0.001). High FIGO risk score (OR 4.21, 95% CI: 1.58-10.92), metastasis (OR 6.78, 95% CI: 1.44-32.60), and plateau/rising β-hCG trends (OR 5.64, 95% CI: 2.10-12.80) were significant predictors of poor outcome. Conclusion: Serial serum β-hCG trends are highly predictive of clinical outcomes in PGTN. A declining β-hCG pattern is strongly associated with complete remission, while plateau or rising trends significantly indicate persistent disease and recurrence. High FIGO risk score, metastatic disease, and elevated baseline β-hCG further increase the likelihood of treatment failure. Early recognition of abnormal β-hCG kinetics enables timely intervention and improves prognosis. Routine and structured β-hCG monitoring should be considered an essential component of PGTN management protocols to enhance risk stratification, guide chemotherapy decisions, and optimize long-term survival outcomes in affected patients.