Assisted Reproductive Technology, Pregnancy, and Recurrent Disease in Melanoma Patients: A 30-Year Single Institution Experience.

IF 2 4区 医学 Q2 OBSTETRICS & GYNECOLOGY
Sander Kelderman, Jorine de Haan, Dachmar Rhijnsburger, Abigael Bouwman, Christianne De Groot, John Haanen, John Coulter, Winan Van Houdt, Frédéric Amant, Christianne Lok
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引用次数: 0

Abstract

Objectives: The primary aim of this study was to assess differences in melanoma recurrence between patients conceiving spontaneously versus those undergoing assisted reproductive technology (ART) and to determine use of ART in post-melanoma patients. A secondary aim was to describe the use of immunotherapy as a novel treatment regimen for metastatic melanoma in a cohort of fertile patients.

Design: This study is a 30-year analysis including data from a single-center questionnaire and a retrospective cohort study. Participants/Materials: Women of childbearing age with a history of melanoma were requested to participate in our study. We selected patients who underwent either primary melanoma treatment or treatment of local/distant recurrence at our institute between 1994 and 2021. Each participant received a questionnaire and informed consent form. The questions concerned general health, primary tumor characteristics, utilization of ART, subsequent pregnancies, and development of recurrent melanoma. Additional information was collected from the medical files.

Setting: The research was conducted in a dedicated oncology center and tertiary referral center for melanoma in The Netherlands.

Methods: Participants received the questionnaires by mail. Six weeks later a reminder was sent to nonresponders. Analysis was performed using descriptive statistics. For comparisons between groups, chi-square tests were used. p value was considered significant when below 0.05. A clinically relevant difference in recurrence rate was defined as a 10% difference.

Results: A total of 498 questionnaires were available for analyses, 449 from living patients and 49 from relatives of diseased patients. One hundred and seventy-nine patients (36%) with a history of melanoma became pregnant following their diagnosis. There was no difference in the recurrence rate between patients who became pregnant after the diagnosis of melanoma and those who never subsequently conceived (37% vs. 35%, p = 0.609). In the total cohort, 28 patients (6%) attempted to conceive using ART, and eight of them experienced disease recurrence. A total of 58 patients (22% of patients since 2006) were treated with immunotherapy.

Limitations: The main limitations of the study are its size, observational design, and questionnaire methodology.

Conclusions: Pregnancy did not increase the risk of recurrent melanoma. The group of patients conceiving after ART was small, and therefore, it is difficult to confidently conclude that the recurrence risk is comparable to the other groups. Prospective international registration of these patients, their oncologic follow-up and possible use of assisted reproduction, will provide valuable information to determine any potential association between ART and risk of recurrent melanoma. This would enable health professionals to develop surveillance strategies and preconception counseling of patients wishing to conceive.

黑色素瘤患者的辅助生殖技术、妊娠和复发疾病:30 年的单一机构经验。
研究目的 本研究旨在评估自然受孕患者与接受辅助生殖技术(ART)治疗的患者在黑色素瘤复发方面的差异,确定黑色素瘤术后患者对 ART 的使用情况,并研究对这一特殊患者群体进行咨询的影响。设计 本研究是一项为期 30 年的分析,包括来自单个中心问卷调查和回顾性队列研究的数据。参与者/材料 我们要求有黑色素瘤病史的育龄妇女参与研究。我们选择了 1994 年至 2021 年期间在本研究所接受原发性黑色素瘤治疗或局部/远处复发治疗的患者。每位参与者都收到了一份调查问卷和知情同意书。问题涉及一般健康状况、原发肿瘤特征、抗逆转录病毒疗法的使用情况、后续妊娠情况以及黑色素瘤复发情况。其他信息则从医疗档案中收集。研究地点 研究在荷兰一家专门的肿瘤中心和黑色素瘤三级转诊中心进行。方法 参与者通过邮件收到问卷。六周后向未回复者发送催复函。采用描述性统计方法进行分析。组间比较采用卡方检验。P 值低于 0.05 即为显著。复发率的临床相关性差异定义为 10%。结果 共有 498 份问卷可供分析,其中 449 份来自在世患者,49 份来自患者亲属。179名有黑色素瘤病史的患者(36%)在确诊后怀孕。在这组患者中,有 28 名患者(16%)试图通过抗逆转录病毒疗法受孕,其中 8 人疾病复发。确诊黑色素瘤后怀孕的患者与从未怀孕的患者的复发率没有差异(37% vs 35%,P=0.609)。局限性 该研究的主要局限性在于其规模、观察性设计和问卷调查方法。结论 怀孕不会增加黑色素瘤复发的风险。抗逆转录病毒疗法后怀孕的患者人数较少,因此很难有把握地断定复发风险与其他组别相当。对这些患者进行前瞻性的国际登记、肿瘤学随访以及可能使用的辅助生殖技术,将为确定抗逆转录病毒疗法与黑色素瘤复发风险之间的潜在联系提供宝贵的信息。这将有助于医疗专业人员制定监控策略,并为希望怀孕的患者提供孕前咨询。
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来源期刊
CiteScore
4.20
自引率
4.80%
发文量
44
审稿时长
6-12 weeks
期刊介绍: This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.
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