Melin Johanna, Madanat-Harjuoja Laura, Heinävaara Sirpa, Malila Nea, Gissler Mika, Tiitinen Aila
a Finnish Cancer Registry , Institute for Statistical and Epidemiological Cancer Research , Helsinki , Finland.
b Department of Obstetrics and Gynecology , Kymenlaakso Central Hospital , Kotka , Finland.
Acta Oncol. 2017 Aug;56(8):1089-1093. doi: 10.1080/0284186X.2017.1304653. Epub 2017 Mar 24.
Long-term survival rates for most types of childhood cancers have improved dramatically over the past decades. However, because of advances in multimodality treatments, cancer survivors nowadays more often face long-term complications, including diminished gonadal and reproductive function. The aim of this study was to identify whether the use of fertility treatments among early onset (0-34 years) cancer survivors giving birth differed from that among siblings giving birth and to identify the subgroups of cancer survivors that were most likely to require fertility treatments.
Nationwide cancer and birth registries were merged to identify 1974 post-diagnosis deliveries of cancer survivors and 6107 deliveries of female siblings in 2004-2013. Unconditional multivariate logistic regression models were used to estimate the risk for different fertility treatments namely assisted reproductive technology, intrauterine insemination and ovulation induction. We adjusted for maternal age, year of delivery, parity and smoking.
We found overall significantly increased odds for use of any fertility treatments in survivors compared to siblings (OR 1.84, 95% CI 1.18-2.86). As time from cancer treatment increased, the odds for need of fertility treatments increased, being highest at 11 to 15 years post cancer treatment (OR 2.88, 95% CI 1.13-7.30). Survivors diagnosed at ages 25-34 years had the highest odds for use of fertility treatments compared to siblings (OR 2.31, 95% CI 1.01-5.32).
Our study supports previous findings indicating that cancer survivors have an increased risk for subfertility. Survivors diagnosed in their childhood had the lowest risk for fertility treatment and seemed to get pregnant with less extensive fertility treatments than survivors diagnosed as adults. Time elapsed from cancer treatment played a central role, increasing the need for fertility treatments compared to siblings, suggesting that cancer therapies might lead to diminished ovarian reserve.
在过去几十年中，大多数类型儿童癌症的长期生存率有了显著提高。然而，由于多模式治疗的进展，如今癌症幸存者更常面临长期并发症，包括性腺和生殖功能减退。本研究的目的是确定早发型（0 - 34岁）癌症幸存者分娩时使用生育治疗的情况与分娩的兄弟姐妹相比是否存在差异，并确定最有可能需要生育治疗的癌症幸存者亚组。
合并全国癌症和出生登记处的数据，以识别2004 - 2013年间1974例癌症幸存者诊断后分娩情况以及6107例女性兄弟姐妹的分娩情况。使用无条件多变量逻辑回归模型来估计不同生育治疗（即辅助生殖技术、宫内人工授精和促排卵）的风险。我们对产妇年龄、分娩年份、产次和吸烟情况进行了调整。
我们发现，与兄弟姐妹相比，幸存者总体上使用任何生育治疗的几率显著增加（比值比1.84，95%置信区间1.18 - 2.86）。随着癌症治疗后时间的增加，需要生育治疗的几率增加，在癌症治疗后11至15年时最高（比值比2.88，95%置信区间1.13 - 7.30）。与兄弟姐妹相比，25 - 34岁诊断出癌症的幸存者使用生育治疗的几率最高（比值比2.31，95%置信区间1.01 - 5.32）。
我们的研究支持先前的发现，即癌症幸存者生育力低下的风险增加。儿童期诊断出癌症的幸存者接受生育治疗的风险最低，并且似乎比成年后诊断出癌症的幸存者在接受范围较小的生育治疗后就能怀孕。癌症治疗后的时间起着核心作用，与兄弟姐妹相比，生育治疗的需求增加，这表明癌症治疗可能导致卵巢储备减少。
