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[妊娠、激素制剂与恶性黑色素瘤]

[Pregnancy, hormone preparations and malignant melanoma].

作者信息

Garbe C

机构信息

Universitäts-Hautklinik und Poliklinik, Klinikum Steglitz, Freien Universität Berlin.

出版信息

Hautarzt. 1993 Jun;44(6):347-52.

PMID:8335457
Abstract

For decades pregnancy has been regarded as an unfavourable prognostic factor in women with malignant melanoma and for many patients termination of pregnancy was recommended. Likewise, it was suspected that pregnancy during the first few years after diagnosis of the tumor would impair the prognosis and, therefore, a contraindication was established. An analysis of the data of the Central Malignant Melanoma Registry of the German Dermatological Society revealed that 1% of female melanoma patients were pregnant and 40.5% were found to be in premenopausal status. In several recent studies survival rates of melanoma patients who were pregnant and those who became pregnant after diagnosis were compared to the rates in women without pregnancies. No significant differences were found. In addition, the use of oral contraceptives and menopausal estrogens, which were formerly thought to be related to an elevated risk of developing melanoma, was shown not to affect the risk and natural course of malignant melanoma. In conclusion, the recent results of extensive investigations no longer substantiate recommendations for abortion in pregnant melanoma patients. The use of oral contraceptives and menopausal estrogens is likewise no longer contraindicated in melanoma patients. A waiting period before having children may be recommended in the first 2-3 years after diagnosis, as this is the period with the highest probability of relapse, and one can be more certain that the course will be favourable.

摘要

几十年来,怀孕一直被视为恶性黑色素瘤女性患者的不良预后因素,许多患者被建议终止妊娠。同样,人们怀疑在肿瘤诊断后的头几年内怀孕会损害预后,因此确立了怀孕为禁忌证。对德国皮肤病学会中央恶性黑色素瘤登记处的数据进行分析后发现,1%的女性黑色素瘤患者处于孕期,40.5%处于绝经前状态。在最近的几项研究中,将孕期黑色素瘤患者以及诊断后怀孕的患者的生存率与未怀孕女性的生存率进行了比较。未发现显著差异。此外,以前认为与患黑色素瘤风险升高有关的口服避孕药和绝经后雌激素的使用,并未显示会影响恶性黑色素瘤的风险和自然病程。总之,广泛调查的最新结果不再支持对怀孕的黑色素瘤患者进行流产的建议。黑色素瘤患者同样不再禁忌使用口服避孕药和绝经后雌激素。在诊断后的头2至3年内,建议等待一段时间再生育,因为这是复发概率最高的时期,这样可以更确定病程会是有利的。

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