{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:06:00Z","timestamp":1788278760343,"version":"build-2803163510"},"reference-count":27,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior\u2013Brasil (CAPES)\u2013Maesta, I: Process","award":["CAPES-PRINT-88887.936692\/2024-00"],"award-info":[{"award-number":["CAPES-PRINT-88887.936692\/2024-00"]}]},{"name":"S\u00e3o Paulo Research Foundation-FAPESP","award":["#2018\/10698-9"],"award-info":[{"award-number":["#2018\/10698-9"]}]}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Cancers"],"abstract":"<jats:p>Objectives: To evaluate the potential associations of the type of complete hydatidiform mole (CHM) initial treatment (hysterectomy or uterine evacuation) with GTN development, need for chemotherapy, and treatment outcome in women aged \u2265 40 years. Methods: This multicentric retrospective cohort study included women \u2265 40 years with CHM, initially treated between 1990 and 2018, at four different centers. Data collected included patient demographics and clinical characteristics. The outcome variables were post-CHM GTN development, need for chemotherapy for hCG normalization, surgical complications, and time to remission. Univariate and multivariate analyses were performed using chi-square, Mann\u2013Whitney, Fisher\u2019s exact tests, and Poisson regression. Results: 275 women with CHM aged \u2265 40 years were included in the analysis. Median patient age was significantly higher among hysterectomy patients (47 \u00d7 44 years, p = 0.01). Multivariate analysis showed that compared with uterine evacuation (244\/275, 89%), hysterectomy (31\/275, 11%) was associated with an 83% lower risk of GTN [RR = 0.17 95% CI = (0.04\u20130.71); p = 0.015] and a 92% lower risk of requiring chemotherapy [RR: 0.08 (0.01\u20130.64), p = 0.016]. Median time to hCG normalization did not statistically differ between treatments. No significant differences were observed between hysterectomy and uterine evacuation in terms of FIGO staging (p = 0.221) or prognostic risk score (p = 0.576). Resistance to first-line chemotherapy (17\/72; 23.6%) and relapse (3\/72; 4.1%) were observed only in patients undergoing initial uterine evacuation. Hysterectomy complications occurred in 45.1% (14) of the patients. Conclusions: CHM initial treatment with hysterectomy was associated with a lower risk for GTN occurrence and need for chemotherapy in women aged 40 years or older. However, shared decision-making about surgery should be tailored to each patient and their risk factors and preferences. Further, larger controlled studies are required to support our findings.<\/jats:p>","DOI":"10.3390\/cancers17193125","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T06:02:52Z","timestamp":1758866572000},"page":"3125","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Initial Treatment and Outcomes of Complete Hydatidiform Mole in Women 40 Years or Older: A Multicenter Cohort Study"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4279-4515","authenticated-orcid":false,"given":"Cec\u00edlia Can\u00eado Freitas","family":"Desmarais","sequence":"first","affiliation":[{"name":"Postgraduation Program in Tocogynecology, Medical School, S\u00e3o Paulo State University (UNESP), Av. Professor M\u00e1rio Rubens Guimar\u00e3es Montenegro, s\/n\u00b0, Botucatu 18618-687, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izildinha","family":"Maest\u00e1","sequence":"additional","affiliation":[{"name":"Postgraduation Program in Tocogynecology, Medical School, S\u00e3o Paulo State University (UNESP), Av. Professor M\u00e1rio Rubens Guimar\u00e3es Montenegro, s\/n\u00b0, Botucatu 18618-687, SP, Brazil"},{"name":"Botucatu Trophoblastic Disease Center, Medical School, S\u00e3o Paulo State University (UNESP), Av. Professor M\u00e1rio Rubens Guimar\u00e3es Montenegro, s\/n\u00b0, Botucatu 18618-687, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6573-7386","authenticated-orcid":false,"given":"Sue Yazaki","family":"Sun","sequence":"additional","affiliation":[{"name":"S\u00e3o Paulo Hospital Trophoblastic Disease Center, Paulista School of Medicine, S\u00e3o Paulo Federal University, R. Napole\u00e3o de Barros, 715-Vila Clementino, S\u00e3o Paulo 04024-002, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2193-3374","authenticated-orcid":false,"given":"Jorge","family":"de Rezende-Filho","sequence":"additional","affiliation":[{"name":"Rio de Janeiro Trophoblastic Disease Center, Maternity School, Rio de Janeiro Federal University, Rua das Laranjeiras, 180, Laranjeiras, Rio de Janeiro 22240-003, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto Antonio","family":"de Ara\u00fajo Costa","sequence":"additional","affiliation":[{"name":"Medical School, S\u00e3o Paulo State University (UNESP), Av. Professor M\u00e1rio Rubens Guimar\u00e3es Montenegro, s\/n\u00b0, Botucatu 18618-687, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence Hsu","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariza","family":"Branco-Silva","sequence":"additional","affiliation":[{"name":"Postgraduation Program in Tocogynecology, Medical School, S\u00e3o Paulo State University (UNESP), Av. Professor M\u00e1rio Rubens Guimar\u00e3es Montenegro, s\/n\u00b0, Botucatu 18618-687, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil S.","family":"Horowitz","sequence":"additional","affiliation":[{"name":"New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women\u2019s Hospital, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Elias","sequence":"additional","affiliation":[{"name":"Section of Gynecologic Oncology, Obstetrics and Gynecology Institute, Taussig Cancer Institute, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2942-6182","authenticated-orcid":false,"given":"Antonio","family":"Braga","sequence":"additional","affiliation":[{"name":"Rio de Janeiro Trophoblastic Disease Center, Maternity School, Rio de Janeiro Federal University, Rua das Laranjeiras, 180, Laranjeiras, Rio de Janeiro 22240-003, RJ, Brazil"},{"name":"Department of Maternal and Child Health, Postgraduate Program in Medical Sciences, School of Medicine, Fluminense Federal University (UFF), Niter\u00f3i 24070-090, RJ, Brazil"},{"name":"Postgraduate Program in Applied Health Sciences, University of Vassouras, Vassouras 27700-000, RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross S.","family":"Berkowitz","sequence":"additional","affiliation":[{"name":"New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women\u2019s Hospital, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA 02215, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/0002-9378(78)90792-5","article-title":"The syndromes of hydatidiform mole","volume":"132","author":"Szulman","year":"1978","journal-title":"Am. 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Open"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3125\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T11:50:29Z","timestamp":1759146629000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":27,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["cancers17193125"],"URL":"https:\/\/doi.org\/10.3390\/cancers17193125","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]}}}