Green Daniel M, Whitton John A, Stovall Marilyn, Mertens Ann C, Donaldson Sarah S, Ruymann Frederick B, Pendergrass Thomas W, Robison Leslie L
Department of Pediatrics, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
J Clin Oncol. 2003 Feb 15;21(4):716-21. doi: 10.1200/JCO.2003.04.085.
This study was undertaken to determine the effect, if any, on pregnancy loss, live births, and birthweight of treatment for cancer diagnosed during childhood or adolescence.
We reviewed pregnancy outcome among sexually active male Childhood Cancer Survivor Study (CCSS) participants who responded to a questionnaire before February 3, 2000. Medical records of all members of the cohort were abstracted to obtain chemotherapeutic agents administered, the cumulative dose of drug administered for several drugs of interest, and the doses, volumes, and dates of administration of all radiotherapy.
There were 4,106 sexually active males; 1,227 reported they sired 2,323 pregnancies (69% live births, 1% stillbirths, 13% miscarriages, 13% abortions, 5% unknown or in gestation). The male-to-female ratio of the offspring of the partners of the male survivors was significantly different from that of the offspring of the partners of the male siblings of the survivors (1.0:1.03 v 1.24:1.0) (P =.016). The proportion of pregnancies of the partners of male survivors that ended with a liveborn infant was significantly lower than for the partners of the male siblings of the survivors who were the control group for comparison (relative risk = 0.77, P =.007). There were no significant differences in pregnancy outcome by treatment.
This large study did not identify adverse pregnancy outcomes for the partners of male survivors treated with most chemotherapeutic agents. The reversal of the sex ratio and the association observed for procarbazine warrant further investigation.
本研究旨在确定儿童期或青春期诊断出的癌症治疗对妊娠丢失、活产及出生体重是否有影响(若有影响,则确定其影响程度)。
我们回顾了参与儿童癌症幸存者研究(CCSS)且有性活动的男性参与者的妊娠结局,这些参与者在2000年2月3日前回复了一份问卷。提取该队列所有成员的病历,以获取所给予的化疗药物、几种感兴趣药物的累积给药剂量,以及所有放疗的剂量、体积和给药日期。
有4106名有性活动的男性;1227人报告他们致使伴侣怀孕2323次(69%为活产,1%为死产,13%为流产,13%为堕胎,5%情况不明或仍在妊娠中)。男性幸存者伴侣的后代中男女比例与幸存者男性同胞伴侣的后代男女比例显著不同(1.0:1.03对1.24:1.0)(P = 0.016)。男性幸存者伴侣妊娠并以活产婴儿结束的比例显著低于作为对照组的幸存者男性同胞的伴侣(相对风险 = 0.77,P = 0.007)。不同治疗方式的妊娠结局无显著差异。
这项大型研究未发现大多数化疗药物治疗的男性幸存者的伴侣存在不良妊娠结局。对于丙卡巴肼观察到的性别比例逆转及相关性值得进一步研究。