Prognostic significance of trophoblastic differentiation and β-hCG secretion in somatic malignancies of uterine corpus: A systematic review with survival analysis.

Abstract

Background: Trophoblastic differentiation or beta-human chorionic gonadotropin (β-hCG) secretion in endometrial carcinoma has been associated with poorly differentiated and aggressive tumors; however, the evidence is largely inconclusive. The review aimed to explore the prognostic role of trophoblastic differentiation and β-hCG in non-trophoblastic, primary uterine corpus cancers.

Methodology: A comprehensive electronic search across databases was conducted for all cases of cancers of the uterine corpus that were either associated with elevated levels of β-hCG or showed evidence of trophoblastic differentiation upon microscopy or both. Cases of gestational choriocarcinoma, trophoblastic tumors, tumors other than uterine corpus, and those tumors of uterine corpus but not reporting β-hCG as a marker were excluded. Data regarding patients' clinic-demographic details, tumor characteristics, β-hCG levels at the time of presentation, and how these values change with treatment, its peak levels, the extent of loco-regional metastasis, details of treatment received, and case fatality were extracted and analysed statistically.

Results: A total of 35 case reports/case series with a total of 40 cases were included in the present review. The mean age at presentation was 57.75 ± 17.22 years. Nulliparity, obesity, hypertension, and diabetes were important risk factors. Post-menopausal or abnormal uterine bleeding was the commonest presenting complaint. Trophoblastic differentiation or β-hCG expression was found to be associated with high tumor grade, poor differentiation, and poor overall patient survival. The lung was the most common site of metastasis.

Conclusions: Trophoblastic differentiation or elaboration of β-hCG in cancers of the uterine corpus is a rarity, and the majority of them are associated with a grim prognosis, secondary to being associated with poor differentiation, early hematogenous dissemination, and resistance to chemo-radiotherapy. Measurement of pre-operative β-hCG may be considered in all cases of endometrial carcinomas and sarcomas, and if found elevated, immunohistochemical examination with β-hCG should be carried out.