Department of Gynecology and Obstetrics, Botucatu Medical School, Postgraduate Program of Gynecology, Obstetrics and Mastology of São Paulo State University. Rubião Júnior District, Botucatu, São Paulo, Brazil; Rio de Janeiro Trophoblastic Disease Center, Brazilian Association of Gestational Trophoblastic Disease, 180 Laranjeiras St, Laranjeiras, Rio de Janeiro, RJ, Brazil.
Department of Gynecology and Obstetrics, Botucatu Medical School, Postgraduate Program of Gynecology, Obstetrics and Mastology of São Paulo State University. Rubião Júnior District, Botucatu, São Paulo, Brazil.
Gynecol Oncol. 2017 Nov;147(2):364-370. doi: 10.1016/j.ygyno.2017.09.007. Epub 2017 Sep 18.
To evaluate the influence of hormonal contraception (HC) on the development and clinical aggressiveness of gestational trophoblastic neoplasia (GTN) and the time for normalization of human chorionic gonadotropin (hCG) levels.
A retrospective cohort study was conducted with women diagnosed with molar pregnancy, followed at the Rio de Janeiro Trophoblastic Disease Center, between January 2005 and January 2015. The occurrence of postmolar GTN and the time for hCG normalization between users of HC or barrier methods (BM) during the postmolar follow-up or GTN treatment were evaluated.
Among 2828 patients included in this study, 2680 (95%) used HC and 148 (5%) used BM. The use of HC did not significantly influence the occurrence of GTN (ORa: 0.66, 95% CI: 0.24-1.12, p=0.060), despite different formulations: progesterone-only (ORa: 0.54, 95% CI: 0.29-1.01, p=0.060) or combined oral contraception (COC) (ORa: 0.50, 95% CI: 0.27-1.01, p=0.60) or with different dosages of ethinyl estradiol: 15mcg (ORa, 1.33, 95% CI 0.79-2.24, p=0.288), 20mcg (ORa: 1.02, 95% CI: 0.64-1.65, p=0.901), 30mcg (ORa: 1.17, 95% CI: 0.78-1.75, p=0.437) or 35mcg (ORa: 0.77, 95% CI: 0.42-1.39, p=0.386). Time to hCG normalization ≥10weeks (ORa: 0.58, 95% CI: 0.43-1.08, p=0.071) or time to remission with chemotherapy≥14weeks (ORa: 0.60, 95% CI: 0.43-1.09, p=0.067) did not significantly differ among HC users when compared to patients using BM, when controlling for other risk factors using multivariate logistic regression.
The use of HC during postmolar follow-up or GTN treatment does not seem to increase the risk of GTN or its severity and does not postpone the normalization of hCG levels.
评估激素避孕（HC）对妊娠滋养细胞肿瘤（GTN）的发展和临床侵袭性的影响，以及人绒毛膜促性腺激素（hCG）水平正常化的时间。
这是一项回顾性队列研究，对 2005 年 1 月至 2015 年 1 月在里约热内卢滋养细胞疾病中心接受治疗的葡萄胎患者进行随访。评估在葡萄胎后随访或 GTN 治疗期间使用 HC 或屏障方法（BM）的患者中，发生滋养细胞肿瘤后和 hCG 正常化的时间。
在这项研究中，纳入了 2828 名患者，其中 2680 名（95%）使用了 HC，148 名（5%）使用了 BM。尽管使用了不同的配方（孕激素或复方口服避孕药）和不同剂量的炔雌醇（15mcg、20mcg、30mcg 或 35mcg），HC 的使用并未显著增加 GTN 的发生风险（ORa：0.66，95%CI：0.24-1.12，p=0.060）。使用 HC 也不会显著影响 GTN 的严重程度（ORa：0.54，95%CI：0.29-1.01，p=0.060）或导致 hCG 水平正常化的时间延迟（HC 使用者中 hCG 水平正常化≥10 周的比例为 0.58，95%CI：0.43-1.08，p=0.071）或需要化疗缓解的时间≥14 周的比例为 0.60，95%CI：0.43-1.09，p=0.067）。
在葡萄胎后随访或 GTN 治疗期间使用 HC 似乎不会增加 GTN 的发生风险或其严重程度，也不会延迟 hCG 水平的正常化。
