| Objective : Based on retrospective analyze and follow-up study of medical records, we are able to analyze the clinical condition of gestational trophoblastic neoplasm(GTN) and explore the pregnancy situation and psychological influence of patients who complete the chemotherapy more than one year.Methods:From January 2008 to December 2013,97 cases who were diagnosed of gestational trophoblastic neoplasm and had complete response after chemotherapy of 5-Fu and Actin-D with more than one year after chemotherapy in The Second Hospital of Hebei Medical University were recruited. By making calls and sending mails,we achieve GTN pregnancy situation and psychological influence. According to GTN clinical stage,the GTN patients who desired to conceive and had fertility were divided into two groups: A group(n=49) who had GTN Ⅰ stage which included invasive hydatidiform mole Ⅰphase and choriocarcinoma Ⅰphase and B group(n=49) who had GTNⅢ stage which included invasive hydatidiform mole Ⅲ phase and choriocarcinoma Ⅲphase. Two groups of patients were compared of pregnancy rate,term delivery rate,premature delivery rate, wastage rate, gestation age, the pregnant interval after chemotherapy and the chemotherapy cycle. Analyze the condition of pulmonary metastasis,surgical treatment and psychological changes worrying about disease recurrence, psychological discomfort of sexual activity and disease recurrence along with gestation of patients who had invasive hydatidiform mole and choriocarcinoma. Summarize the contraceptive method in nonpregnant patients who had no fertility requirements but have fertility. Data were processed using SPSS 19.0 software.Results : All of 97 GTN patients had complete remission after chemotherapy,the CR rate was 100% and no other chemotherapy regimens. There were 76 patients who had fertility requirement and had the ability of pregnancy,16 patients with no fertility requirements or unable to have children,5 cases lost to follow-up and follow-up rate was 94.85%(92/97).(1) Pregnancy condition:There were 42 pregnant patients in 76 cases(42/76, 55.26%).The comparison of pregnancy rate of A group which was 59.26%(16/27) and B group which was 53.06%(26/49) was not statistically different(χ2 =0.27,P>0.05). The average age was 23.50±3.44(21-33)years old in A group and 23.61±3.09(20-30)years old in B group,and the comparison of the average age between two groups was not statistically different(t=-0.11, P>0.05).The average interval between pregnancy and chemotherapy was 20.88±3.24( 15-28) months in A group and 21.61±3.05(17-29) months in B group, and the comparison of the interval between two groups was not statistically different(t=0.75,P>0.05). The comparison of term delivery rate of pregnant patients in A group which was 55.56%(15/27) and in B group which was 51.02%(25/49),there was 1 patients who had reterm delivery in group A and no patient in group B,there was no embryo damage in group A and 1 case in group B. There was no statistical difference of term delivery rate, reterm delivery and wastage rate of two groups(P>0.05);Children of GTN patients including term and preterm deliveries all live and as healthy and intelligent as other healthy children in their ages.The abortion times before GTN was 1.13±1.20 in A group and 0.62±0.64 in B group,and the comparison of the interval between two groups was not statistically different(t=1.80,P>0.05).(2)Chemotherapy condition:There was no statistical difference of average time of chemotherapy treatment between A group which was 4.11±1.26(2-6)and B group which was 4.75±1.62(3-9)(t=-2.04,P>0.05). There was no statistical difference of average time of chemotherapy treatment of pregnant patients between A group which was 3.88±1.20(2-5) and B group which was 5.08±1.85(3-9)(t=-2.31,P>0.05).(3)Pulmonary metastasis and operation situation:47cases of 72 invasive hydatidiform mole patients had pulmonary metastasis and 10 cases of 25 choriocarcinoma patients had pulmonary metastasis. There was statistical difference of pulmonary metastasis between invasive hydatidiform mole patients and choriocarcinoma patients(χ2 =4.89,P<0.05),which indicated that invasive hydatidiform mole patients had more chance of pulmonary metastasis. There were 11 cases who had operation treatment which accounted for 11.34% of all the patients. 6 of them had total hysterectomy. 4 of them had uterus lesion resection.1 of them had the surgical repair of uterine rupture.(4)Psychological impact: 27 patients worried about disease recurrence(27/92,29.35%),13 patients were afraid of pregnancy(13/92,14.13%)and 5 patients felt psychological discomfort in sexual life(5/92,5.43%)among the 92 follow-up GTN patients.(5)The condition of non-pregnancy patients: There were 34 patients who desired to conceive and had fertility. 3 of them didn’t conceive without contraception,11 using appliancemethod(11/31,35.48%),12 using IUD(12/31,38.71%),8 patients with contraception behavior(8/31,25.81%). There were no contraceptive failure events and associated abnormal uterine bleeding with all the contraceptive methods.Conclusions:1 GTN patients can have normal pregnancy after one year interval of“ two guns” chemotherapy.2 Clinical stage and pulmonary metastasis have no adverse effect on che-motherapy cycle and fertility.3 Some patients of GTN still have psychological shadow and fear pregnancy after treatment. |
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