PDF(Pubmed)
Abstract：
BACKGROUND: Chemotherapy is crucial in treating gestational trophoblastic neoplasia (GTN), but its impact on gonadotoxicity is unclear.
METHODS: This case-control study included 57 GTN patients and 19 age-matched patients with molar pregnancies (MP) in 2012-2018. Multiples of the median (MoM) of the serum AMH levels were compared between the two groups, and between patients using single-agent and combination chemotherapy, at baseline, 6, 12, and 24 months after treatment. Their pregnancy outcomes were also compared.
RESULTS: There was no significant difference in the MoM of serum AMH between GTN and MP groups at all time points. Single-agent chemotherapy did not adversely affect the MoM. However, those receiving combination chemotherapy had lower MoM than those receiving single-agent chemotherapy at all time points. The trend of decline from the baseline was marginally significant in patients with combination chemotherapy, but the drop was only significant at 12 months (Z = -2.69, p = 0.007) but not at 24 months (Z = -1.90; p = 0.058). Multivariable analysis revealed that combination chemotherapy did not affect the MoM. There was no significant difference in the 4-year pregnancy rate and the livebirth rate between the single-agent and combination groups who attempting pregnancy, but it took 1 year longer to achieve the first pregnancy in the combination group compared to the single-agent group (2.88 vs. 1.88 years).
CONCLUSIONS: This study showed combination chemotherapy led to a decreasing trend of MoM of serum AMH especially at 12 months after treatment, but the drop became static at 24 months. Although pregnancy is achievable, thorough counseling is still needed in this group especially those wish to achieve pregnancy 1-2 years after treatment or with other risk factors.
METHODS: This case-control study included 57 GTN patients and 19 age-matched patients with molar pregnancies (MP) in 2012-2018. Multiples of the median (MoM) of the serum AMH levels were compared between the two groups, and between patients using single-agent and combination chemotherapy, at baseline, 6, 12, and 24 months after treatment. Their pregnancy outcomes were also compared.
RESULTS: There was no significant difference in the MoM of serum AMH between GTN and MP groups at all time points. Single-agent chemotherapy did not adversely affect the MoM. However, those receiving combination chemotherapy had lower MoM than those receiving single-agent chemotherapy at all time points. The trend of decline from the baseline was marginally significant in patients with combination chemotherapy, but the drop was only significant at 12 months (Z = -2.69, p = 0.007) but not at 24 months (Z = -1.90; p = 0.058). Multivariable analysis revealed that combination chemotherapy did not affect the MoM. There was no significant difference in the 4-year pregnancy rate and the livebirth rate between the single-agent and combination groups who attempting pregnancy, but it took 1 year longer to achieve the first pregnancy in the combination group compared to the single-agent group (2.88 vs. 1.88 years).
CONCLUSIONS: This study showed combination chemotherapy led to a decreasing trend of MoM of serum AMH especially at 12 months after treatment, but the drop became static at 24 months. Although pregnancy is achievable, thorough counseling is still needed in this group especially those wish to achieve pregnancy 1-2 years after treatment or with other risk factors.
摘要：
背景：化疗对于治疗妊娠滋养细胞肿瘤（GTN）至关重要，但其对性腺毒性的影响尚不清楚。
方法：这项病例对照研究包括2012-2018年57例GTN患者和19例年龄匹配的磨牙妊娠（MP）患者。比较两组患者血清AMH水平中位数(MoM)的倍数,以及使用单药和联合化疗的患者之间，在基线，治疗后6、12和24个月。还比较了他们的妊娠结局。
结果：在所有时间点，GTN和MP组之间的血清AMHMoM均无显着差异。单药化疗对MoM无不良影响。然而,在所有时间点,接受联合化疗的患者的MoM均低于接受单药化疗的患者.联合化疗患者从基线下降的趋势不明显，但下降仅在12个月时显著(Z=-2.69,p=0.007),而在24个月时则不显著(Z=-1.90;p=0.058).多变量分析显示联合化疗对MoM无影响。尝试怀孕的单药组和组合组之间的4年妊娠率和活产率没有显着差异，但与单药组相比，联合组需要1年的时间才能实现首次怀孕（2.88vs.1.88年）。
结论：本研究显示联合化疗导致血清AMHMoM呈下降趋势，尤其是在治疗后12个月。但是下降在24个月时变得静态。虽然怀孕是可以实现的，在这一群体中,尤其是那些希望在治疗后1-2年或有其他危险因素的人,仍需要进行彻底的咨询.
方法：这项病例对照研究包括2012-2018年57例GTN患者和19例年龄匹配的磨牙妊娠（MP）患者。比较两组患者血清AMH水平中位数(MoM)的倍数,以及使用单药和联合化疗的患者之间，在基线，治疗后6、12和24个月。还比较了他们的妊娠结局。
结果：在所有时间点，GTN和MP组之间的血清AMHMoM均无显着差异。单药化疗对MoM无不良影响。然而,在所有时间点,接受联合化疗的患者的MoM均低于接受单药化疗的患者.联合化疗患者从基线下降的趋势不明显，但下降仅在12个月时显著(Z=-2.69,p=0.007),而在24个月时则不显著(Z=-1.90;p=0.058).多变量分析显示联合化疗对MoM无影响。尝试怀孕的单药组和组合组之间的4年妊娠率和活产率没有显着差异，但与单药组相比，联合组需要1年的时间才能实现首次怀孕（2.88vs.1.88年）。
结论：本研究显示联合化疗导致血清AMHMoM呈下降趋势，尤其是在治疗后12个月。但是下降在24个月时变得静态。虽然怀孕是可以实现的，在这一群体中,尤其是那些希望在治疗后1-2年或有其他危险因素的人,仍需要进行彻底的咨询.
