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[乳腺癌治疗后的妊娠]

[Pregnancy after Treatment of Breast Cancer].

作者信息

Petráková K, Holánek M

出版信息

Klin Onkol. 2016 Fall;29 Suppl 3:S23-28. doi: 10.14735/amko20163S23.

Abstract

Thanks to improvement in cancer patients treatment results, growing attention has been paid to fertility issues. Physicians should discuss infertility risk and the possibilities of fertility preservation with all patients in reproductive age as soon as possible. Pregnancy in cancer survivors after adequate treatment should not be discouraged, including patients with endocrine-sensitive breast cancer. Embryo and oocyte cryopreservation are standard strategies for fertility cryopreservation. Several randomized clinical trials have addressed the role of LHRHa (luteinizing hormone-releasing hormone analogs) as a way of fertility preservation with conflicting results. A meta-analysis of clinical trials, including also the largest trials POEMS and PROMISE, showed higher odds of achieving pregnancy. These data suggest that giving LHRHa before and during adjuvant chemotherapy could also be a reliable strategy to preserve ovarian function and fertility. The use of ovarian stimulating drugs in standard treatment protocols for ovarian stimulation in female cancer patients is safe according to current data. The meta-analysis of 14 studies did not show negative influence of pregnancy on overall survival of female cancer patients although the optimal interval between breast cancer diagnosis and pregnancy is not known. However, breast cancer patients are in higher risk of preterm labor and low birth weight of infants.Key words: breast neoplasms - fertility preservation - ovarian stimulation - LHRH - pregnancy - tamoxifen - aromatase inhibitors - adjuvant hormonal therapyThis work was supported by MEYS - NPS I - LO1413.The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 3. 8. 2016Accepted: 11. 8. 2016.

摘要

得益于癌症患者治疗效果的改善,生育问题日益受到关注。医生应尽快与所有育龄患者讨论不孕风险及生育力保存的可能性。在接受充分治疗后,不应阻碍癌症幸存者怀孕,包括内分泌敏感型乳腺癌患者。胚胎和卵母细胞冷冻保存是生育力冷冻保存的标准策略。多项随机临床试验探讨了促黄体生成素释放激素类似物(LHRHa)在生育力保存方面的作用,但结果相互矛盾。一项对临床试验的荟萃分析,其中也包括最大规模的试验POEMS和PROMISE,显示怀孕几率更高。这些数据表明,在辅助化疗前及化疗期间使用LHRHa也可能是一种保存卵巢功能和生育力的可靠策略。根据目前的数据,在女性癌症患者的标准卵巢刺激治疗方案中使用卵巢刺激药物是安全的。对14项研究的荟萃分析未显示怀孕对女性癌症患者总生存期有负面影响,尽管乳腺癌诊断与怀孕之间的最佳间隔尚不清楚。然而,乳腺癌患者早产和婴儿低出生体重的风险更高。关键词:乳腺肿瘤 - 生育力保存 - 卵巢刺激 - 促黄体生成素释放激素 - 怀孕 - 他莫昔芬 - 芳香化酶抑制剂 - 辅助激素治疗 本研究得到了MEYS - NPS I - LO1413的支持。作者声明他们在研究中使用的药物、产品或服务方面不存在潜在利益冲突。编辑委员会声明该手稿符合国际医学期刊编辑委员会对生物医学论文的推荐要求。提交日期:2016年8月3日 接受日期:2016年8月11日

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