Jakes Adam D, Marec-Berard Perrine, Phillips Robert S, Stark Daniel P
Leeds Institute of Oncology, Leeds Teaching Hospitals NHS Trust , Leeds, United Kingdom .
Institut d'Hématologie et d'Oncologie Pédiatrie (IHOP) , Lyon, France .
J Adolesc Young Adult Oncol. 2014 Dec 1;3(4):144-152. doi: 10.1089/jayao.2014.0032.
The 5-year survival of teenagers and young adults (TYAs; 13-24 years old) with cancer has continued to rise, but as a result more patients experience late effects of treatment, such as infertility. Advice regarding fertility preservation in relation to cancer is provided in numerous clinical practice guidelines, but the rigor of their development is unclear. A systematic search was undertaken for clinical practice guidelines regarding fertility preservation in TYAs with cancer. All guidelines were reviewed according to the Appraisal of Guidelines for Research and Evaluation (AGREE-II) criteria. Five out of 13 identified guidelines scored over 75% in the "rigor of development" section and were further appraised. Content, scope, and consistencies between recommendations were also examined. All five of the reviewed guidelines encouraged oncologists to have discussions with their patients about potential fertility issues associated with treatment and available fertility preservation methods. The cryopreservation of sperm, oocytes, and embryos were all recommended as first-line interventions in postpubertal patients. Recommendations surrounding pre- or peripubescent adolescents were few, with many techniques only recommended as part of a clinical trial. The risk of subfertility associated with different treatment regimens was poorly described. The methodology and development of guidelines describing fertility preservation in TYA cancer patients varied greatly. Methodological quality did not clearly influence key recommendations. Those involved with the development of guidelines are encouraged to clearly define their development methods to allow users to be confident of the quality.
青少年和青年（13至24岁）癌症患者的5年生存率持续上升，但因此更多患者出现治疗的晚期效应，如不孕不育。众多临床实践指南都提供了有关癌症患者生育力保存的建议，但其制定的严谨性尚不清楚。我们对有关青少年和青年癌症患者生育力保存的临床实践指南进行了系统检索。所有指南均根据《研究与评价指南评估（AGREE-II）》标准进行审查。在13份已确定的指南中，有5份在“制定的严谨性”部分得分超过75%，并进行了进一步评估。还检查了建议之间的内容、范围和一致性。所有5份经审查的指南都鼓励肿瘤学家与患者讨论与治疗相关的潜在生育问题以及可用的生育力保存方法。精子、卵母细胞和胚胎的冷冻保存均被推荐为青春期后患者的一线干预措施。关于青春期前或青春期前后青少年的建议很少，许多技术仅作为临床试验的一部分被推荐。不同治疗方案相关的生育力低下风险描述不足。描述青少年和青年癌症患者生育力保存的指南在方法和制定方面差异很大。方法学质量并未明显影响关键建议。鼓励参与指南制定的人员明确界定其制定方法，以使使用者对质量充满信心。
