Int J Gynecol Cancer. 2018 Feb;28(2):332-337. doi: 10.1097/IGC.0000000000001175.
Gestational trophoblastic neoplasia affects women of reproductive age and is usually treated by chemotherapy. Major concerns related to chemotherapy in young women are the possible infertility, risk of early menopause, and teratogenic effects on subsequent pregnancies. The study's aim was to analyze menstrual and reproductive outcomes of women treated with single-agent versus multiagent chemotherapy for gestational trophoblastic neoplasia.
One-hundred fifty-one patients were treated. Seventy-six patients older than 45 years, with a placental site or epithelioid trophoblastic tumor, undergoing hysterectomy for patient choice, or undergoing human chorionic gonadotropin follow-up at the time of the analysis were excluded. Seventy-five patients were divided into subgroups according to International Federation of Gynecology and Obstetrics score: patients scoring less than 7, receiving single-agent chemotherapy (group A, n = 42); patients scoring 7 or greater, receiving combination treatment (group B, n = 33). Patients' outcomes were compared by univariate and multivariate analyses.
Temporary amenorrhea occurred in 33% of group A patients and 66.7% of group B (P = 0.01). Premature menopause occurred in 3 patients in group B (0% vs 9%, P = 0.02). Ten patients in group B underwent salvage hysterectomy. Pregnancy desire did not differ between the 2 groups (P = 0.555). In group A, 57.1% became pregnant; in group B, 36.4% did (P = 0.060). Instead, pregnancy rate was 52.2% among high-risk patients not undergoing hysterectomy (57.1% vs 52.2%, P = 0.449). There was no difference in miscarriage (P = 0.479) and premature birth (P = 0.615) rates. In a multivariate analysis that included age, International Federation of Gynecology and Obstetrics score, chemotherapy type, use of assisted reproductive technologies, previous pregnancies, and pregnancy desire, only age (P = 0.006) and pregnancy desire (P = 0.002) had a significant impact on the probability to have subsequent pregnancies.
Except for the risk of premature ovarian failure, a rare adverse effect of combined treatments, both single-agent and multiagent chemotherapy can be safely administered to patients with a desire for childbearing. High-risk patients have worse reproductive outcomes because they undergo hysterectomy more frequently than low-risk patients.
滋养细胞肿瘤影响育龄妇女，通常采用化疗治疗。年轻女性接受化疗的主要关注点是可能导致不孕、早绝经以及对后续妊娠的致畸作用。本研究旨在分析采用单药与联合化疗治疗滋养细胞肿瘤的女性的月经和生殖结局。
共纳入 151 例患者。排除 76 例年龄大于 45 岁、因患者选择行子宫切除术、胎盘部位或上皮样滋养细胞肿瘤、或在分析时进行人绒毛膜促性腺激素随访的患者，以及因国际妇产科联合会评分：评分＜7 分且接受单药化疗（A 组，n=42）或评分≥7 分且接受联合治疗（B 组，n=33）的患者。采用单因素和多因素分析比较患者结局。
A 组患者中 33%出现暂时闭经，B 组患者中 66.7%出现闭经（P=0.01）。B 组中有 3 例患者出现早绝经（0% vs 9%，P=0.02）。B 组中有 10 例患者行挽救性子宫切除术。两组患者的妊娠意愿无差异（P=0.555）。A 组中有 57.1%的患者妊娠，B 组中有 36.4%的患者妊娠（P=0.060）。而未行子宫切除术的高危患者的妊娠率为 52.2%（57.1% vs 52.2%，P=0.449）。流产率（P=0.479）和早产率（P=0.615）无差异。在包括年龄、国际妇产科联合会评分、化疗类型、辅助生殖技术使用、既往妊娠和妊娠意愿的多因素分析中，只有年龄（P=0.006）和妊娠意愿（P=0.002）对后续妊娠的可能性有显著影响。
除联合治疗罕见的卵巢早衰风险外，单药与联合化疗均可安全用于有生育意愿的患者。高危患者因更频繁地行子宫切除术，其生殖结局更差。
