Department of Biostatistics, The Kirby Institute, University of New South Wales and Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.
Australian Centre for Public Health and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
Clin Breast Cancer. 2018 Feb;18(1):e79-e88. doi: 10.1016/j.clbc.2017.06.016. Epub 2017 Jul 10.
Improvements in local and systemic treatment, along with earlier diagnoses through breast awareness and screening, have led to increases in survival and a decline in breast cancer (BC) recurrence. To the best of our knowledge, no meta-analysis has yet focused on pregnancy outcomes after BC treatment. Hence, our research group explored the reproductive outcomes (pregnancy, miscarriage, termination of pregnancy, live births) after BC treatment. The Embase, MEDLINE, PubMed, and Scopus databases were searched. Studies were included that reported on pregnancy and reproductive outcomes after treatment of BC. A meta-analysis of 16 studies with subgroup analyses was conducted. In the matched cohort and case-control studies (n = 1287), subgroup analysis showed that women who had received systemic therapy after surgery had an overall pooled estimate of 14% (95% confidence interval [CI], 0.12-0.16; I = 95.4%) of becoming pregnant. Of those who became pregnant, 12% (95% CI, 0.08-0.16; I = 65.9%) experienced a miscarriage. For the population-based studies (n = 711), the estimated pooled pregnancy rate was 3% (95% CI, 0.02-0.03; I = 85.1%) for women who became pregnant after BC treatment. The pregnancy rate after BC treatment for survivors was on average 40% lower than the general population pregnancy rate. Women with BC should be informed about the subsequent adverse effects of BC and its treatments on conception. With the increasing trend for women to defer childbirth to later in life, provision of fertility-related information, access to fertility preservation, and fertility-related psychosocial support should be offered to women of a reproductive age before they begin BC treatment.
局部和全身治疗的改进，以及通过乳房意识和筛查的早期诊断，导致了生存率的提高和乳腺癌（BC）复发率的下降。据我们所知，尚无荟萃分析专门针对 BC 治疗后的妊娠结局。因此，我们的研究小组探讨了 BC 治疗后的生殖结局（怀孕、流产、终止妊娠、活产）。检索了 Embase、MEDLINE、PubMed 和 Scopus 数据库。纳入了报告 BC 治疗后妊娠和生殖结局的研究。对 16 项研究进行了荟萃分析，并进行了亚组分析。在匹配队列和病例对照研究（n=1287）中，亚组分析显示，手术后接受全身治疗的女性总体怀孕估计为 14%（95%置信区间 [CI]，0.12-0.16；I=95.4%）。在怀孕的女性中，12%（95% CI，0.08-0.16；I=65.9%）发生流产。对于基于人群的研究（n=711），BC 治疗后怀孕的女性估计的妊娠率为 3%（95% CI，0.02-0.03；I=85.1%）。BC 治疗后幸存者的妊娠率平均比一般人群的妊娠率低 40%。应该告知 BC 患者 BC 及其治疗对受孕的后续不良影响。随着女性将生育推迟到以后生活的趋势增加，应该在开始 BC 治疗之前为有生育能力的女性提供与生育相关的信息、获得生育保存的机会和与生育相关的心理社会支持。
