Reproductive outcomes after floxuridine-based regimens for gestational trophoblastic neoplasia: A retrospective cohort study in a national referral center in China.
OBJECTIVE
To analyze the reproductive outcomes of gestational trophoblastic neoplasia (GTN) patients who were cured only by floxuridine-based regimens.


METHODS
This was a retrospective analysis of 464 patients who were treated with only floxuridine-based regimens at Peking Union Medical College Hospital between January 2002 and December 2013 and retained their reproductive ability. Their reproductive outcomes were analyzed. The factors affecting pregnancy intention were identified by logistic regression.


RESULTS
Of the 464 patients (average age, 28.0 ± 5.7 years; median follow-up = 85 months), the livebirth rate was 72.2%, while the rates of spontaneous abortion, induced abortion and ectopic pregnancy were 9.2% (n = 41), 8.7% (n = 39) and 1.8% (n = 8), respectively. The GTN recurrence rate was 2.1%. The time from chemotherapy completion to first conception in the induced abortion group was significantly shorter than those in spontaneous abortion, full-term/premature, and ectopic pregnancy groups (P ≤ 0.001, <0.001, =0.015, respectively). The logistic analysis showed that the age at onset of GTN (OR = 0.899, 95% CI 0.851-0.951, P < 0.001), parity at onset of GTN (parity = 1, OR = 0.123, 95% CI 0.068-0.225, P < 0.001; parity = 2-3, OR = 0.058, 95% CI 0.014-0.232, P < 0.001) and interval from the index pregnancy to chemotherapy were independent factors affecting pregnancy intention. Among the 36 pregnancies occurring within 12 months postchemotherapy, only one choriocarcinoma occurred, and 20 culminated in induced abortions (55.6%).


CONCLUSIONS
After floxuridine-based chemotherapy, the pregnancy rate of GTN patients after fertility-preserving treatment is comparable to that of the normal population. Pregnancy losses within one year after chemotherapy completion are mainly caused by induced abortion.
['Jiang|Fang|F|', 'Yang|Kun|K|', 'Wan|Xi-Run|XR|', 'Xiang|Yang|Y|', 'Feng|Feng-Zhi|FZ|', 'Ren|Tong|T|', 'Yang|Jun-Jun|JJ|', 'Zhao|Jun|J|']
D000328:Adult D000964:Antimetabolites, Antineoplastic D002681:China D005260:Female D059247:Fertility Preservation D005467:Floxuridine D031901:Gestational Trophoblastic Disease D006801:Humans D033182:Intention D050498:Live Birth D011247:Pregnancy D012189:Retrospective Studies D061685:Time-to-Pregnancy D055815:Young Adult
Reproductive outcomes Floxuridine-based regimen Gestational trophoblastic neoplasia Pregnancy intention Fertility-sparing treatment