Klosky James L, Wang Fang, Russell Kathryn M, Zhang Hui, Flynn Jessica S, Huang Lu, Wasilewski-Masker Karen, Landier Wendy, Leonard Marcia, Albritton Karen H, Gupta Abha A, Casillas Jacqueline, Colte Paul, Kutteh William H, Schover Leslie R
James L. Klosky, Fang Wang, Kathryn M. Russell, Hui Zhang, Jessica S. Flynn, Lu Huang, and William H. Kutteh, St Jude Children's Research Hospital, Memphis, TN; Karen Wasilewski-Masker, Children's Healthcare of Atlanta and Emory University, Atlanta, GA; Wendy Landier, City of Hope, Duarte; Jacqueline Casillas, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA; Marcia Leonard, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Karen H. Albritton, Cook Children's Medical Center, Fort Worth; Leslie R. Schover, MD Anderson Cancer Center, Houston, TX; Abha A. Gupta, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; and Paul Colte, Primary Children's Hospital, Salt Lake City, UT.
J Clin Oncol. 2017 Dec 1;35(34):3830-3836. doi: 10.1200/JCO.2016.70.4767. Epub 2017 Oct 4.
Purpose To estimate the prevalence of sperm banking among adolescent males newly diagnosed with cancer and to identify factors associated with banking outcomes. Patients and Methods A prospective, single-group, observational study design was used to test the contribution of sociodemographic, medical, psychological/health belief, communication, and developmental factors to fertility preservation outcomes. At-risk adolescent males (N = 146; age 13.00 to 21.99 years; Tanner stage ≥ 3), their parents, and medical providers from eight leading pediatric oncology centers across the United States and Canada completed self-report questionnaires within 1 week of treatment initiation. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% CIs for specified banking outcomes (collection attempt v no attempt and successful completion of banking v no banking). Results Among adolescents (mean age, 16.49 years; standard deviation, 2.02 years), 53.4% (78 of 146) made a collection attempt, with 43.8% (64 of 146) successfully banking sperm (82.1% of attempters). The overall attempt model revealed adolescent consultation with a fertility specialist (OR, 29.96; 95% CI, 2.48 to 361.41; P = .007), parent recommendation to bank (OR, 12.30; 95% CI, 2.01 to 75.94; P = .007), and higher Tanner stage (OR, 5.42; 95% CI, 1.75 to 16.78; P = .003) were associated with an increased likelihood of a collection attempt. Adolescent history of masturbation (OR, 5.99; 95% CI, 1.25 to 28.50; P = .025), banking self-efficacy (OR, 1.23; 95% CI, 1.05 to 1.45; P = .012), and parent (OR, 4.62; 95% CI, 1.46 to 14.73; P = .010) or medical team (OR, 4.26; 95% CI, 1.45 to 12.43; P = .008) recommendation to bank were associated with increased likelihood of sperm banking completion. Conclusion Although findings suggest that banking is underutilized, modifiable adolescent, parent, and provider factors associated with banking outcomes were identified and should be targeted in future intervention efforts.
目的 评估新诊断为癌症的青春期男性精子库保存的普及率，并确定与保存结果相关的因素。患者与方法 采用前瞻性单组观察性研究设计，以检验社会人口学、医学、心理/健康信念、沟通及发育因素对生育力保存结果的影响。来自美国和加拿大8家主要儿科肿瘤中心的有风险的青春期男性（N = 146；年龄13.00至21.99岁； Tanner分期≥3期）、他们的父母及医疗服务提供者在开始治疗的1周内完成了自我报告问卷。多变量逻辑回归用于计算特定保存结果（采集尝试与否以及成功完成保存与否）的比值比（OR）和95%可信区间（CI）。结果 在青少年（平均年龄16.49岁；标准差2.02岁）中，53.4%（146例中的78例）进行了采集尝试，43.8%（146例中的64例）成功保存了精子（占尝试者的82.1%）。总体尝试模型显示，青少年咨询生育专家（OR，29.96；95%CI，2.48至361.41；P = 0.007）、父母建议保存（OR，12.30；95%CI，2.01至75.94；P = 0.007）以及较高的Tanner分期（OR，5.42；95%CI，1.75至16.78；P = 0.003）与采集尝试可能性增加相关。青少年手淫史（OR，5.99；95%CI，1.25至28.50；P = 0.025）、保存自我效能感（OR，1.23；95%CI，1.05至1.45；P = 0.012）以及父母（OR，4.62；95%CI，1.46至14.73；P = 0.010）或医疗团队（OR，4.26；95%CI，1.45至12.43；P = 0.008）建议保存与精子保存完成可能性增加相关。结论 尽管研究结果表明精子库保存未得到充分利用，但已确定了与保存结果相关的可改变的青少年、父母及医疗服务提供者因素，未来的干预措施应针对这些因素。
