Department of Paediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
Hum Reprod. 2011 Jul;26(7):1775-83. doi: 10.1093/humrep/der113. Epub 2011 Apr 12.
This study assessed the long-term effects of cancer therapies on reproductive status in adult male childhood cancer survivors, evaluated the treatment-related risk factors for hypergonadotropic hypogonadism and assessed the association between the FSH levels and the later need for assisted reproductive techniques (ART).
The study cohort included adult male 5-year survivors of childhood cancer who were treated in our institution between 1966 and 2003. Data concerning patient and treatment characteristics, FSH, LH and testosterone levels and pregnancy outcome were collected. Multivariate regression analyses were performed to evaluate the treatment-related risk factors for disturbances in reproductive endocrine status. The diagnostic and predictive values of FSH and later need for ART were evaluated.
Data on reproductive endocrine status were available for 488 survivors (86.4%) of the 565 male survivors who visited the outpatient clinic in adulthood. The median follow-up time from initiation of treatment to first visit to the outpatient clinic in adulthood was 15 years. The prevalence rates of elevated FSH levels and decreased testosterone levels were 33 and 12%, respectively. The use of procarbazine, cyclophosphamide, vinca-alkaloids, other alkylating agents, pelvic/abdominal irradiation, total body irradiation and testicular surgery were identified as treatment-related risk factors for elevated FSH levels. During the follow-up period, 73 men reported 120 conceptions, which resulted in 103 live births. Of these men, 56 (77%) were able to achieve conception naturally. All men whose partners conceived by assisted reproductive techniques (n = 13) had elevated FSH levels at their first visit after their 18th birthday (sensitivity: 100%; 95% CI: 71-100%) and all male survivors with a normal FSH level did not need assisted reproductive techniques (negative predictive value: 100%; 95% CI: 89-100%).
One-third of young adult male survivors of childhood cancer has elevated FSH levels. FSH appears to be a very sensitive marker for the need of assisted reproductive techniques in male childhood cancer survivors.
本研究评估了癌症治疗对成年男性儿童癌症幸存者生殖状况的长期影响，评估了与高促性腺激素性性腺功能减退症相关的治疗相关风险因素，并评估了 FSH 水平与随后需要辅助生殖技术（ART）之间的关系。
研究队列包括在我们机构接受治疗的 1966 年至 2003 年期间的成年男性儿童癌症 5 年幸存者。收集了有关患者和治疗特征、FSH、LH 和睾酮水平以及妊娠结局的数据。进行多变量回归分析以评估生殖内分泌状态紊乱的治疗相关风险因素。评估了 FSH 的诊断和预测价值以及随后对 ART 的需求。
在成年后到门诊就诊的 565 名男性幸存者中，有 488 名（86.4%）有生殖内分泌状态的数据。从开始治疗到成年后首次就诊的中位随访时间为 15 年。升高的 FSH 水平和降低的睾酮水平的患病率分别为 33%和 12%。使用丙卡巴肼、环磷酰胺、长春碱类、其他烷化剂、盆腔/腹部放疗、全身放疗和睾丸手术被确定为升高 FSH 水平的治疗相关风险因素。在随访期间，73 名男性报告了 120 次妊娠，导致 103 次活产。在这些男性中，56 名（77%）能够自然受孕。所有通过辅助生殖技术受孕的男性（n=13）的伴侣在 18 岁生日后首次就诊时 FSH 水平升高（灵敏度：100%；95%CI：71-100%），所有 FSH 水平正常的男性幸存者都不需要辅助生殖技术（阴性预测值：100%；95%CI：89-100%）。
三分之一的年轻成年男性儿童癌症幸存者 FSH 水平升高。FSH 似乎是男性儿童癌症幸存者需要辅助生殖技术的非常敏感的标志物。
