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{{Choriocarcinoma}}
{{Gestational trophoblastic neoplasia}}
{{CMG}}{{AE}}{{MD}}
{{CMG}}{{AE}}{{Sab}}
 


==Overview==
==Overview==
Common [[Risk factor|risk factors]] in the development choriocarcinoma include extremes of parental [[Reproduction|reproductive]] age, history of [[gestational trophoblastic disease]], [[Reproduction|reproductive]] factors such as [[Parity (medicine)|parity]] and abortion, parental [[Blood type|blood group]], [[oral contraceptive]] use, [[Genetics|genetic]] factors, and environmental and lifestyle factors.


==Risk factors==
==Risk factors==
===Parental Age===
'''Maternal'''
*The risk of choriocarcinoma increases progressively in women older than 25 years ([[relative risk]] 1·4).<ref name="pmid6705308">{{cite journal |vauthors=Buckley JD |title=The epidemiology of molar pregnancy and choriocarcinoma |journal=Clin Obstet Gynecol |volume=27 |issue=1 |pages=153–9 |date=March 1984 |pmid=6705308 |doi= |url=}}</ref>
*The risk increases more rapidly in women older than 39 years ([[relative risk]] 10·8).<ref name="pmid6705308">{{cite journal |vauthors=Buckley JD |title=The epidemiology of molar pregnancy and choriocarcinoma |journal=Clin Obstet Gynecol |volume=27 |issue=1 |pages=153–9 |date=March 1984 |pmid=6705308 |doi= |url=}}</ref>
*The risk is higher for women younger than 20 compared with women aged 20 – 24 years ([[relative risk]] 1·5).<ref name="pmid6705308">{{cite journal |vauthors=Buckley JD |title=The epidemiology of molar pregnancy and choriocarcinoma |journal=Clin Obstet Gynecol |volume=27 |issue=1 |pages=153–9 |date=March 1984 |pmid=6705308 |doi= |url=}}</ref>
'''Paternal'''
*A [[Case-control|case-control study]] by La Vecchia ''et al'' revealed increased risk of [[gestational trophoblastic disease]] in general in women with husbands older than 40 ([[Relative risk|RR]]= 1.6 [95% [[Confidence interval|CI]] 0·9 – 6·0] for age 41 - 45 years and [[Relative risk|RR]]= 4.9 [95% [[Confidence interval|CI]] 2·2 – 11·1] for age > 45 years).<ref name="pmid6088880">{{cite journal |vauthors=La Vecchia C, Parazzini F, Decarli A, Franceschi S, Fasoli M, Favalli G, Negri E, Pampallona S |title=Age of parents and risk of gestational trophoblastic disease |journal=J. Natl. Cancer Inst. |volume=73 |issue=3 |pages=639–42 |date=September 1984 |pmid=6088880 |doi= |url=}}</ref>
*Paternal age > 45 years can also independently be associated with an increased risk of [[Complete hydatidiform mole|complete hydatidiform mole (CHM)]], a potential prerequisite of choriocarcinoma ([[Relative risk|RR]]= 2.9).<ref name="ParazziniVecchia1986">{{cite journal|last1=Parazzini|first1=F.|last2=Vecchia|first2=C. La|last3=Pampallona|first3=S.|title=Parental age and risk of complete and partial hydatidiform mole|journal=BJOG: An International Journal of Obstetrics and Gynaecology|volume=93|issue=4|year=1986|pages=582–585|issn=1470-0328|doi=10.1111/j.1471-0528.1986.tb07957.x}}</ref>


===Known risk factors===
===History of Gestational Trophoblastic Disease===
There is convincing evidence that the following factors increase your risk for gestational trophoblastic disease (gestational trophoblastic disease (GTD)).
*Previous history of [[hydatidiform mole]] is associated with a 1000 – 2000 times increased risk of choriocarcinoma.<ref name="pmid6705308">{{cite journal |vauthors=Buckley JD |title=The epidemiology of molar pregnancy and choriocarcinoma |journal=Clin Obstet Gynecol |volume=27 |issue=1 |pages=153–9 |date=March 1984 |pmid=6705308 |doi= |url=}}</ref>
====Child-bearing age====
*The risk of choriocarcinoma after a [[Complete hydatidiform mole|complete hydatidiform mole (CHM)]] is about 2500 times higher than after a live birth.<ref name="pmid6705308">{{cite journal |vauthors=Buckley JD |title=The epidemiology of molar pregnancy and choriocarcinoma |journal=Clin Obstet Gynecol |volume=27 |issue=1 |pages=153–9 |date=March 1984 |pmid=6705308 |doi= |url=}}</ref>
Gestational trophoblastic disease (GTD) occurs in women of child-bearing age. The risk is higher in women who become [[pregnant]] over the age of 40 and those who become pregnant under the age of 20.
====Previous hydatidiform mole====
Women who have a [[hydatidiform mole]], or molar pregnancy, are at a higher risk of having another one or having another type of gestational trophoblastic disease (GTD). A woman’s risk increases with a history of more than one hydatidiform mole.
====Family history of gestational trophoblastic disease (GTD)====
Although it is rare, there is a type of gestational trophoblastic disease (GTD) that occurs in families (familial). Therefore, a family history of gestational trophoblastic disease (GTD) may increase your risk.


===Possible risk factors===
===Reproductive Factors===
The following factors have been linked with gestational trophoblastic disease (GTD), but there is not enough evidence to show they are known risk factors. Further study is needed to clarify the role of these factors for gestational trophoblastic disease (GTD).
*Studies on [[gestational trophoblastic disease]] in general have shown a [[relative risk]] of 0·6 - 1·0 for [[Parity (medicine)|parous]] women compared with [[Parity (medicine)|nulliparous]] women.<ref name="BrintonWu1989">{{cite journal|last1=Brinton|first1=Louise A.|last2=Wu|first2=Bao-Zhen|last3=Wang|first3=Wen|last4=Ershow|first4=Abby G.|last5=Song|first5=Hong-Zhao|last6=Li|first6=Jun-Yao|last7=Bracken|first7=Michael B.|last8=Blot|first8=William J.|title=Gestational trophoblastic disease: A case-control study from the People's Republic of China|journal=American Journal of Obstetrics and Gynecology|volume=161|issue=1|year=1989|pages=121–127|issn=00029378|doi=10.1016/0002-9378(89)90248-2}}</ref><ref name="ParazziniLaVecchia1985">{{cite journal|last1=Parazzini|first1=Fabio|last2=LaVecchia|first2=Carlo|last3=Pampallona|first3=Sandro|last4=Franceschi|first4=Silvia|title=Reproductive patterns and the risk of gestational trophoblastic disease|journal=American Journal of Obstetrics and Gynecology|volume=152|issue=7|year=1985|pages=866–870|issn=00029378|doi=10.1016/S0002-9378(85)80079-X}}</ref><ref name="pmid2990199">{{cite journal |vauthors=La Vecchia C, Franceschi S, Parazzini F, Fasoli M, Decarli A, Gallus G, Tognoni G |title=Risk factors for gestational trophoblastic disease in Italy |journal=Am. J. Epidemiol. |volume=121 |issue=3 |pages=457–64 |date=March 1985 |pmid=2990199 |doi= |url=}}</ref>
====Oral contraceptives====
*[[Parity (medicine)|Parous]] women also have an increased risk of choriocarcinoma ([[Relative risk|RR]] above unity). But this association is significant only for more than five births ([[Relative risk|RR]]= 5.2).<ref name="pmid8896386">{{cite journal |vauthors=Ha MC, Cordier S, Bard D, Le TB, Hoang AH, Hoang TQ, Le CD, Abenhaim L, Nguyen TN |title=Agent orange and the risk of gestational trophoblastic disease in Vietnam |journal=Arch. Environ. Health |volume=51 |issue=5 |pages=368–74 |date=1996 |pmid=8896386 |doi=10.1080/00039896.1996.9934424 |url=}}</ref>
Several studies have shown a possible link between using [[oral contraceptives]] (birth control pills) and an increased risk of gestational trophoblastic disease (GTD). But recent studies suggest that there is no association or that the association is weak.
*Abortion is associated with an increased risk of [[gestational trophoblastic disease]] in general ([[Relative risk|RR]]= 1.1 - 3.3).<ref name="pmid10087749">{{cite journal |vauthors=Talati NJ |title=The pattern of benign gestational trophoblastic disease in Karachi |journal=J Pak Med Assoc |volume=48 |issue=10 |pages=296–300 |date=October 1998 |pmid=10087749 |doi= |url=}}</ref><ref name="MesserliLilienfeld1985">{{cite journal|last1=Messerli|first1=Marti L.|last2=Lilienfeld|first2=Abraham M.|last3=Parmley|first3=Tim|last4=Woodruff|first4=J. Donald|last5=Rosenshein|first5=Neil B.|title=Risk factors for gestational trophoblastic neoplasia|journal=American Journal of Obstetrics and Gynecology|volume=153|issue=3|year=1985|pages=294–300|issn=00029378|doi=10.1016/S0002-9378(85)80115-0}}</ref><ref name="BrintonWu1989">{{cite journal|last1=Brinton|first1=Louise A.|last2=Wu|first2=Bao-Zhen|last3=Wang|first3=Wen|last4=Ershow|first4=Abby G.|last5=Song|first5=Hong-Zhao|last6=Li|first6=Jun-Yao|last7=Bracken|first7=Michael B.|last8=Blot|first8=William J.|title=Gestational trophoblastic disease: A case-control study from the People's Republic of China|journal=American Journal of Obstetrics and Gynecology|volume=161|issue=1|year=1989|pages=121–127|issn=00029378|doi=10.1016/0002-9378(89)90248-2}}</ref><ref name="ParazziniLaVecchia1985">{{cite journal|last1=Parazzini|first1=Fabio|last2=LaVecchia|first2=Carlo|last3=Pampallona|first3=Sandro|last4=Franceschi|first4=Silvia|title=Reproductive patterns and the risk of gestational trophoblastic disease|journal=American Journal of Obstetrics and Gynecology|volume=152|issue=7|year=1985|pages=866–870|issn=00029378|doi=10.1016/S0002-9378(85)80079-X}}</ref><ref name="pmid2990199">{{cite journal |vauthors=La Vecchia C, Franceschi S, Parazzini F, Fasoli M, Decarli A, Gallus G, Tognoni G |title=Risk factors for gestational trophoblastic disease in Italy |journal=Am. J. Epidemiol. |volume=121 |issue=3 |pages=457–64 |date=March 1985 |pmid=2990199 |doi= |url=}}</ref>
====Reproductive factors====
*The risk of choriocarcinoma increases with [[Parity (medicine)|parity]]. The [[relative risk]] based on parity is as follows:
Some reproductive factors may increase the risk of gestational trophoblastic disease (GTD). These factors include [[infertility]], a history of miscarriage, not having children, having had many children (5 or more), [[menarche]] after 12 years of age and a light [[menstrual]] flow.
:*[[Parity (medicine)|Para]] 1 ([[Relative risk|RR]]= 1.3, 95% [[Confidence interval|CI]]: 0·6–3·0)<ref name="pmid8896386">{{cite journal |vauthors=Ha MC, Cordier S, Bard D, Le TB, Hoang AH, Hoang TQ, Le CD, Abenhaim L, Nguyen TN |title=Agent orange and the risk of gestational trophoblastic disease in Vietnam |journal=Arch. Environ. Health |volume=51 |issue=5 |pages=368–74 |date=1996 |pmid=8896386 |doi=10.1080/00039896.1996.9934424 |url=}}</ref>
====Blood types====
:*[[Parity (medicine)|Para]] 2 ([[Relative risk|RR]]= 1.0, 95% [[Confidence interval|CI]]: 0·4 – 2·8)<ref name="pmid8896386">{{cite journal |vauthors=Ha MC, Cordier S, Bard D, Le TB, Hoang AH, Hoang TQ, Le CD, Abenhaim L, Nguyen TN |title=Agent orange and the risk of gestational trophoblastic disease in Vietnam |journal=Arch. Environ. Health |volume=51 |issue=5 |pages=368–74 |date=1996 |pmid=8896386 |doi=10.1080/00039896.1996.9934424 |url=}}</ref>
Some studies have suggested that women with certain blood types are at increased risk of developing gestational trophoblastic disease (GTD). These are women with type A or AB blood, or women with blood type A who have male partners with blood type O.
:*[[Parity (medicine)|Para]] 3 ([[Relative risk|RR]]= 2.0, 95% [[Confidence interval|CI]]: 0·7 – 5·6)
:*[[Parity (medicine)|Para]] 4 ([[Relative risk|RR]]= 5.2, 95% [[Confidence interval|CI]]: 1·6 – 17·5)
*The risk of choriocarcinoma also increases with the history of abortion. [[Relative risk]] for 1 and 2 abortions is 1.2 (95% [[Confidence interval|CI]]: 0·5–2·9) and 0.8 (95% [[Confidence interval|CI]]: 0·3 – 2·5) respectively.<ref name="pmid8896386">{{cite journal |vauthors=Ha MC, Cordier S, Bard D, Le TB, Hoang AH, Hoang TQ, Le CD, Abenhaim L, Nguyen TN |title=Agent orange and the risk of gestational trophoblastic disease in Vietnam |journal=Arch. Environ. Health |volume=51 |issue=5 |pages=368–74 |date=1996 |pmid=8896386 |doi=10.1080/00039896.1996.9934424 |url=}}</ref>
*A study on choriocarcinoma from Vietnam has shown a [[relative risk]] of 0·3 for a history of induced abortions.<ref name="pmid8896386">{{cite journal |vauthors=Ha MC, Cordier S, Bard D, Le TB, Hoang AH, Hoang TQ, Le CD, Abenhaim L, Nguyen TN |title=Agent orange and the risk of gestational trophoblastic disease in Vietnam |journal=Arch. Environ. Health |volume=51 |issue=5 |pages=368–74 |date=1996 |pmid=8896386 |doi=10.1080/00039896.1996.9934424 |url=}}</ref>


===Unknown risk factors===
===Parental Blood Group===
It isn’t known whether or not the following factors are linked with gestational trophoblastic disease (GTD). It may be that researchers can’t show a definite link or that studies have had different results. Further study is needed to see if the following are risk factors for gestational trophoblastic disease (GTD):
*Women of [[Blood type|blood group]] A married to males of [[Blood type|blood group]] O have the highest risk of chroiocarcinoma compared to women of [[Blood type|blood group]] A married to males of [[Blood type|blood group]] A ([[Relative risk|RR]]= 10.4).<ref name="BagshaweRawlins1971">{{cite journal|last1=Bagshawe|first1=K.D.|last2=Rawlins|first2=G.|last3=Pike|first3=M.C.|last4=Lawler|first4=SylviaD.|title=ABO BLOOD-GROUPS IN TROPHOBLASTIC NEOPLASIA|journal=The Lancet|volume=297|issue=7699|year=1971|pages=553–557|issn=01406736|doi=10.1016/S0140-6736(71)91159-7}}</ref>
* vitamin A deficiency
* socio-economic status


===Oral Contraceptives===
*The risk of choriocarcinoma increases with the use of [[Oral contraceptive|oral contraceptives]]. [[Relative risk]] ranges from 2.0 to 6.4.<ref name="pmid1088402">{{cite journal |vauthors=Baltazar JC |title=Epidemiological features of choriocarcinoma |journal=Bull. World Health Organ. |volume=54 |issue=5 |pages=523–32 |date=1976 |pmid=1088402 |pmc=2366480 |doi= |url=}}</ref><ref name="pmid3338071">{{cite journal |vauthors=Buckley JD, Henderson BE, Morrow CP, Hammond CB, Kohorn EI, Austin DF |title=Case-control study of gestational choriocarcinoma |journal=Cancer Res. |volume=48 |issue=4 |pages=1004–10 |date=February 1988 |pmid=3338071 |doi= |url=}}</ref><ref name="PalmerDriscoll1999">{{cite journal|last1=Palmer|first1=J. R.|last2=Driscoll|first2=S. G.|last3=Rosenberg|first3=L.|last4=Berkowitz|first4=R. S.|last5=Lurain|first5=J. R.|last6=Soper|first6=J.|last7=Twiggs|first7=L. B.|last8=Gershenson|first8=D. M.|last9=Kohorn|first9=E. I.|last10=Berman|first10=M.|last11=Shapiro|first11=S.|last12=Rao|first12=R. S.|title=Oral Contraceptive Use and Risk of Gestational Trophoblastic Tumors|journal=JNCI Journal of the National Cancer Institute|volume=91|issue=7|year=1999|pages=635–640|issn=0027-8874|doi=10.1093/jnci/91.7.635}}</ref>
*The use of [[Oral contraceptive|oral contraceptives]] after a [[Hydatidiform mole|molar]] evacuation increases the risk of invasive mole and choriocarcinoma by approximately three times.<ref name="pmid6705308">{{cite journal |vauthors=Buckley JD |title=The epidemiology of molar pregnancy and choriocarcinoma |journal=Clin Obstet Gynecol |volume=27 |issue=1 |pages=153–9 |date=March 1984 |pmid=6705308 |doi= |url=}}</ref>
===Genetic Factors===
[[Mutation]] in the following [[Gene|genes]] has been associated with recurrent [[hydatidiform mole]]:
*[[NLRP7|NLR family, pyrin domain-containing 7 (NLRP7)]]<ref name="pmid16462743">{{cite journal |vauthors=Murdoch S, Djuric U, Mazhar B, Seoud M, Khan R, Kuick R, Bagga R, Kircheisen R, Ao A, Ratti B, Hanash S, Rouleau GA, Slim R |title=Mutations in NALP7 cause recurrent hydatidiform moles and reproductive wastage in humans |journal=Nat. Genet. |volume=38 |issue=3 |pages=300–2 |date=March 2006 |pmid=16462743 |doi=10.1038/ng1740 |url=}}</ref><ref name="pmid21885028">{{cite journal |vauthors=Parry DA, Logan CV, Hayward BE, Shires M, Landolsi H, Diggle C, Carr I, Rittore C, Touitou I, Philibert L, Fisher RA, Fallahian M, Huntriss JD, Picton HM, Malik S, Taylor GR, Johnson CA, Bonthron DT, Sheridan EG |title=Mutations causing familial biparental hydatidiform mole implicate c6orf221 as a possible regulator of genomic imprinting in the human oocyte |journal=Am. J. Hum. Genet. |volume=89 |issue=3 |pages=451–8 |date=September 2011 |pmid=21885028 |pmc=3169823 |doi=10.1016/j.ajhg.2011.08.002 |url=}}</ref>
*KHDC3-like protein, subcortical maternal complex member (KHDC3L)<ref name="pmid16462743">{{cite journal |vauthors=Murdoch S, Djuric U, Mazhar B, Seoud M, Khan R, Kuick R, Bagga R, Kircheisen R, Ao A, Ratti B, Hanash S, Rouleau GA, Slim R |title=Mutations in NALP7 cause recurrent hydatidiform moles and reproductive wastage in humans |journal=Nat. Genet. |volume=38 |issue=3 |pages=300–2 |date=March 2006 |pmid=16462743 |doi=10.1038/ng1740 |url=}}</ref><ref name="pmid21885028">{{cite journal |vauthors=Parry DA, Logan CV, Hayward BE, Shires M, Landolsi H, Diggle C, Carr I, Rittore C, Touitou I, Philibert L, Fisher RA, Fallahian M, Huntriss JD, Picton HM, Malik S, Taylor GR, Johnson CA, Bonthron DT, Sheridan EG |title=Mutations causing familial biparental hydatidiform mole implicate c6orf221 as a possible regulator of genomic imprinting in the human oocyte |journal=Am. J. Hum. Genet. |volume=89 |issue=3 |pages=451–8 |date=September 2011 |pmid=21885028 |pmc=3169823 |doi=10.1016/j.ajhg.2011.08.002 |url=}}</ref>
===Environmental and Lifestyle Factors===
*There is limited information regarding the association of [[gestational trophoblastic disease]] in general and [[smoking]], [[alcohol]], [[Diet (nutrition)|diet]], socioeconomic status, and [[herbicide]] exposure.
*[[Relative risk]] is > 2 for [[Hydatidiform mole|hydatidiform mole (HM)]] and choriocarcinoma in [[Smoking|smoker]] women. The risk increases with longer duration ([[Relative risk|RR]] for ≥10 years 4·2; 95% [[Confidence interval|CI]] 1·6 – 10·8).<ref name="pmid1088402">{{cite journal |vauthors=Baltazar JC |title=Epidemiological features of choriocarcinoma |journal=Bull. World Health Organ. |volume=54 |issue=5 |pages=523–32 |date=1976 |pmid=1088402 |pmc=2366480 |doi= |url=}}</ref><ref name="pmid2990199">{{cite journal |vauthors=La Vecchia C, Franceschi S, Parazzini F, Fasoli M, Decarli A, Gallus G, Tognoni G |title=Risk factors for gestational trophoblastic disease in Italy |journal=Am. J. Epidemiol. |volume=121 |issue=3 |pages=457–64 |date=March 1985 |pmid=2990199 |doi= |url=}}</ref><ref name="pmid8896386">{{cite journal |vauthors=Ha MC, Cordier S, Bard D, Le TB, Hoang AH, Hoang TQ, Le CD, Abenhaim L, Nguyen TN |title=Agent orange and the risk of gestational trophoblastic disease in Vietnam |journal=Arch. Environ. Health |volume=51 |issue=5 |pages=368–74 |date=1996 |pmid=8896386 |doi=10.1080/00039896.1996.9934424 |url=}}</ref>


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Common risk factors in the development choriocarcinoma include extremes of parental reproductive age, history of gestational trophoblastic disease, reproductive factors such as parity and abortion, parental blood group, oral contraceptive use, genetic factors, and environmental and lifestyle factors.

Risk factors

Parental Age

Maternal

  • The risk of choriocarcinoma increases progressively in women older than 25 years (relative risk 1·4).[1]
  • The risk increases more rapidly in women older than 39 years (relative risk 10·8).[1]
  • The risk is higher for women younger than 20 compared with women aged 20 – 24 years (relative risk 1·5).[1]

Paternal

History of Gestational Trophoblastic Disease

Reproductive Factors

  • The risk of choriocarcinoma also increases with the history of abortion. Relative risk for 1 and 2 abortions is 1.2 (95% CI: 0·5–2·9) and 0.8 (95% CI: 0·3 – 2·5) respectively.[7]
  • A study on choriocarcinoma from Vietnam has shown a relative risk of 0·3 for a history of induced abortions.[7]

Parental Blood Group

Oral Contraceptives

Genetic Factors

Mutation in the following genes has been associated with recurrent hydatidiform mole:

Environmental and Lifestyle Factors

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Buckley JD (March 1984). "The epidemiology of molar pregnancy and choriocarcinoma". Clin Obstet Gynecol. 27 (1): 153–9. PMID 6705308.
  2. ↑ La Vecchia C, Parazzini F, Decarli A, Franceschi S, Fasoli M, Favalli G, Negri E, Pampallona S (September 1984). "Age of parents and risk of gestational trophoblastic disease". J. Natl. Cancer Inst. 73 (3): 639–42. PMID 6088880.
  3. ↑ Parazzini, F.; Vecchia, C. La; Pampallona, S. (1986). "Parental age and risk of complete and partial hydatidiform mole". BJOG: An International Journal of Obstetrics and Gynaecology. 93 (4): 582–585. doi:10.1111/j.1471-0528.1986.tb07957.x. ISSN 1470-0328.
  4. ↑ 4.0 4.1 Brinton, Louise A.; Wu, Bao-Zhen; Wang, Wen; Ershow, Abby G.; Song, Hong-Zhao; Li, Jun-Yao; Bracken, Michael B.; Blot, William J. (1989). "Gestational trophoblastic disease: A case-control study from the People's Republic of China". American Journal of Obstetrics and Gynecology. 161 (1): 121–127. doi:10.1016/0002-9378(89)90248-2. ISSN 0002-9378.
  5. ↑ 5.0 5.1 Parazzini, Fabio; LaVecchia, Carlo; Pampallona, Sandro; Franceschi, Silvia (1985). "Reproductive patterns and the risk of gestational trophoblastic disease". American Journal of Obstetrics and Gynecology. 152 (7): 866–870. doi:10.1016/S0002-9378(85)80079-X. ISSN 0002-9378.
  6. ↑ 6.0 6.1 6.2 La Vecchia C, Franceschi S, Parazzini F, Fasoli M, Decarli A, Gallus G, Tognoni G (March 1985). "Risk factors for gestational trophoblastic disease in Italy". Am. J. Epidemiol. 121 (3): 457–64. PMID 2990199.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Ha MC, Cordier S, Bard D, Le TB, Hoang AH, Hoang TQ, Le CD, Abenhaim L, Nguyen TN (1996). "Agent orange and the risk of gestational trophoblastic disease in Vietnam". Arch. Environ. Health. 51 (5): 368–74. doi:10.1080/00039896.1996.9934424. PMID 8896386.
  8. ↑ Talati NJ (October 1998). "The pattern of benign gestational trophoblastic disease in Karachi". J Pak Med Assoc. 48 (10): 296–300. PMID 10087749.
  9. ↑ Messerli, Marti L.; Lilienfeld, Abraham M.; Parmley, Tim; Woodruff, J. Donald; Rosenshein, Neil B. (1985). "Risk factors for gestational trophoblastic neoplasia". American Journal of Obstetrics and Gynecology. 153 (3): 294–300. doi:10.1016/S0002-9378(85)80115-0. ISSN 0002-9378.
  10. ↑ Bagshawe, K.D.; Rawlins, G.; Pike, M.C.; Lawler, SylviaD. (1971). "ABO BLOOD-GROUPS IN TROPHOBLASTIC NEOPLASIA". The Lancet. 297 (7699): 553–557. doi:10.1016/S0140-6736(71)91159-7. ISSN 0140-6736.
  11. ↑ 11.0 11.1 Baltazar JC (1976). "Epidemiological features of choriocarcinoma". Bull. World Health Organ. 54 (5): 523–32. PMC 2366480. PMID 1088402.
  12. ↑ Buckley JD, Henderson BE, Morrow CP, Hammond CB, Kohorn EI, Austin DF (February 1988). "Case-control study of gestational choriocarcinoma". Cancer Res. 48 (4): 1004–10. PMID 3338071.
  13. ↑ Palmer, J. R.; Driscoll, S. G.; Rosenberg, L.; Berkowitz, R. S.; Lurain, J. R.; Soper, J.; Twiggs, L. B.; Gershenson, D. M.; Kohorn, E. I.; Berman, M.; Shapiro, S.; Rao, R. S. (1999). "Oral Contraceptive Use and Risk of Gestational Trophoblastic Tumors". JNCI Journal of the National Cancer Institute. 91 (7): 635–640. doi:10.1093/jnci/91.7.635. ISSN 0027-8874.
  14. ↑ 14.0 14.1 Murdoch S, Djuric U, Mazhar B, Seoud M, Khan R, Kuick R, Bagga R, Kircheisen R, Ao A, Ratti B, Hanash S, Rouleau GA, Slim R (March 2006). "Mutations in NALP7 cause recurrent hydatidiform moles and reproductive wastage in humans". Nat. Genet. 38 (3): 300–2. doi:10.1038/ng1740. PMID 16462743.
  15. ↑ 15.0 15.1 Parry DA, Logan CV, Hayward BE, Shires M, Landolsi H, Diggle C, Carr I, Rittore C, Touitou I, Philibert L, Fisher RA, Fallahian M, Huntriss JD, Picton HM, Malik S, Taylor GR, Johnson CA, Bonthron DT, Sheridan EG (September 2011). "Mutations causing familial biparental hydatidiform mole implicate c6orf221 as a possible regulator of genomic imprinting in the human oocyte". Am. J. Hum. Genet. 89 (3): 451–8. doi:10.1016/j.ajhg.2011.08.002. PMC 3169823. PMID 21885028.
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