Brydøy Marianne, Fosså Sophie D, Klepp Olbjørn, Bremnes Roy M, Wist Erik A, Wentzel-Larsen Tore, Dahl Olav
Department of Oncology, Haukeland University Hospital, Bergen, Norway.
J Natl Cancer Inst. 2005 Nov 2;97(21):1580-8. doi: 10.1093/jnci/dji339.
Studies of fertility in men treated for testicular cancer have mainly addressed serum follicle-stimulating hormone levels and sperm parameters. We assessed post-treatment paternity among long-term survivors of testicular cancer.
Men (n = 1814) who had been treated for unilateral testicular cancer in Norway during 1980 through 1994 were invited to participate in a national multi-center follow-up survey in 1998 through 2002. The participants were allocated to five groups according to the treatment received after orchiectomy, including treatment at relapse (surveillance, retroperitoneal lymph node dissection, radiotherapy, low-dose chemotherapy [i.e., < or = 850 mg cisplatin], and high-dose chemotherapy [i.e., > 850 mg cisplatin]). Cox proportional hazards analysis was used to assess predictive factors for post-treatment paternity. Statistical tests were two-sided.
A total of 1433 men were assessable, of whom 827 were fathers at diagnosis. Post-treatment conception was attempted by 554 men, among whom the overall 15-year actuarial post-treatment paternity rate was 71% (95% confidence interval [CI] = 66% to 75%) without the use of cryopreserved semen. This rate ranged from 48% (95% CI = 30% to 69%) in the high-dose chemotherapy group to 92% (95% CI = 78% to 98%) in the surveillance group (P < .001). The median actuarial time from diagnosis to the birth of the first child after treatment was 6.6 years overall but varied according to treatment. Assisted reproductive technologies were used by 22% of the couples who attempted conception after treatment. Dry ejaculation, treatment group, pretreatment fatherhood, and marital status were statistically significant independent predictors for post-treatment fatherhood, with dry ejaculation as the most important negative factor.
Although the overall paternity rate after treatment for testicular cancer was high, the ability to conceive and the time to conception reflected the intensity of treatment. These data may help inform patients about their future ability to father biological children.
对接受睾丸癌治疗的男性生育能力的研究主要关注血清促卵泡激素水平和精子参数。我们评估了睾丸癌长期幸存者的治疗后生育情况。
邀请1980年至1994年期间在挪威接受单侧睾丸癌治疗的男性（n = 1814）参加1998年至2002年的全国多中心随访调查。根据睾丸切除术后接受的治疗，将参与者分为五组，包括复发时的治疗（监测、腹膜后淋巴结清扫、放疗、低剂量化疗[即≤850 mg顺铂]和高剂量化疗[即> 850 mg顺铂]）。采用Cox比例风险分析评估治疗后生育的预测因素。统计检验为双侧检验。
共有1433名男性可进行评估，其中827名在诊断时已为父亲。554名男性尝试了治疗后受孕，其中在未使用冷冻精液的情况下，总体15年治疗后生育 actuarial 率为71%（95%置信区间[CI] = 66%至75%）。该率在高剂量化疗组中为48%（95% CI = 30%至69%），在监测组中为92%（95% CI = 78%至98%）（P <.001）。从诊断到治疗后第一个孩子出生的中位 actuarial 时间总体为6.6年，但因治疗而异。22%尝试治疗后受孕的夫妇使用了辅助生殖技术。干性射精、治疗组、治疗前父亲身份和婚姻状况是治疗后父亲身份的统计学显著独立预测因素，干性射精是最重要的负面因素。
尽管睾丸癌治疗后的总体生育率较高，但受孕能力和受孕时间反映了治疗强度。这些数据可能有助于告知患者他们未来生育亲生孩子的能力。
