The Role Of GnRha In The Chemotherapy Of Low-risk Trophoblastic Tumors

Background and ObjectivePregnancy trophoblastic tumor(GTN)is a rare tumor originated from pregnancy trophoblastic cells.GTN includes the histopathological morphology of invasive mole(IM),choriocarcinoma(CCA),placental trophoblastic tumor(PSTT),and epithelioid trophoblastic tumor(ETT).The lesions,including those originated from villi and trophoblast cells outside villi,have different degrees of proliferation,invasion and dissemination.Approximately 50% of GTN occurs after hydatidiform pregnancy,25% after miscarriage or ectopic pregnancy,and 25% after full term or preterm birth.The clinical manifestations and treatment methods of choriocarcinoma and glucose invasion are different from those of PSTT and ETT,so they are often referred to as trophoblastic tumors(GTN).According to the 2000 FIGO staging system,GTN was classified as high-risk(?7)and low-risk(<7).At present,the treatment principle of GTN is mainly chemotherapy,supplemented by surgery and radiotherapy.The cure rate of GTN is about 90%,and that of low-risk patients is almost 100%.Most patients with GTN are women of childbearing age.In the treatment process,the damage of chemotherapy drugs on the ovarian function of patients cannot be ignored.With the development of medical level,more and more women want to retain their reproductive ability while treating tumors,which is also the focus of many scholars.GnRHa is a gonadotropin-releasing hormone agonist analogue,which binds to the GnRH receptor on the pituitary gland,inhibits the pituitary function,hinders the synthesis and secretion of FSH and LH,inhibits the ovarian function and keeps the ovary in a static state,thus avoiding the damage of chemotherapy drugs.In recent years,GnRHa has often been used to protect ovarian function in cancer patients during chemotherapy.However,GnRHa is often used in the postoperative adjuvant chemotherapy for breast cancer and ovarian epithelial tumors to protect ovarian function.Whether GnRHa still plays a role in protecting ovarian function during chemotherapy in patients with trophoblastic tumor.it is rarely reported at home and abroad.The aim of this study was to investigate the protective effect of GnRHa on ovarian function during chemotherapy of low-risk trophoblastic tumor,and to provide an economical,safe and effective way to protect ovarian function in patients with trophoblastic tumor.Materials and MethodsA retrospective analysis was performed on 53 low-risk GTN patients with complete data admitted to the first affiliated hospital of zhengzhou university from June 2014 to June 2017.According to whether GnRHa was used in chemotherapy,they were divided into two groups,23 patients using GnRHa were set as the study group,and 30 patients not using GnRHa were set as the control group.Records of two groups of patients,the total course of chemotherapy.All patients were followed up regularly for 1 year after the end of chemotherapy.After chemotherapy,we recorded menstrual status,menstrual recovery time,and Low estrogen presentation.Endocrine hormone levels and follicular counts in basal sinus of ovary were recorded at before,after and 1 year after chemotherapy.SPSS 17.0 statistical software was used for data processing.Quantitative data were expressed as(?x ± s),the comparison between the quantitative data subject to normal distribution was performed by t test,the comparison between the quantitative data subject to normal distribution was performed by chi-square test,and the comparison between the two groups was performed by chi-square test,P < 0.05 was considered statistically significant.Results1.Compared with the control group before and after chemotherapy,FSH increased significantly and AMH,AFC decreased significantly(P < 0.05).There was significant difference between the two groups.2.The average chemotherapy course of the study group and the control group was compared,P=0.568>0.05,and the difference was not statistically significant.3.At the end of chemotherapy,there were 23 cases of menopause in the study group,17 cases of menopause and 10 cases of rare menstruation and reduction of menstrual volumein the control group,with a total of 27 cases.There was no significant difference between the two groups(P =0.249> 0.05).One year after chemotherapy,23 cases recovered menstruation in the study group and 26 cases in the control group.There was no significant difference between the two groups(P < 0.124 > 0.05).The average time of recovery of menstruation between the two group(P=0.002 < 0.05),the difference was statistically significant.4.One year after chemotherapy,one patient in the study group still had Low estrogen presentation such as fever,insomnia,decreased libido and intercourse pain.In the control group,there were 8 patients with fever,insomnia,palpitation,decreased sexual desire,sexual pain and other symptoms.The difference between the two groups was statistically significant(P=0.032< 0.05).5.Before chemotherapy,there was no significant difference in FSH,AMH and AFC between the two groups(P > 0.05).After chemotherapy and one year after chemotherapy,FSH in the study group was significantly lower than that in the control group,while AMH,AFC in the study group was significantly higher than that in the control group.There was significant difference in FSH,AMH,AFC between the two groups(P< 0.05).Conclusions1.Chemotherapy has significant damage to the ovarian reserve function of patients with GTN in the reproductive age.2.GnRHa has a protective effect on ovarian function injury during chemotherapy,and does not affect the therapeutic effect of chemotherapy drugs on patients with GTN,which is worthy of clinical promotion.