1 Paediatric Haematology and Oncology Unit, University Hospital , Saint-Etienne, France .
2 Childhood Cancer Registry of the Rhône-Alpes Region, University of Saint Etienne , Saint-Etienne, France .
J Adolesc Young Adult Oncol. 2018 Aug;7(4):415-423. doi: 10.1089/jayao.2017.0126. Epub 2018 May 31.
To describe fecundity in female survivors of childhood cancer and consider the correlation with quality of life (QOL).
Of 1744 women treated for childhood cancer before the age of 15 years at one of eight French cancer treatment centers between 1948 and 1992, 1187 who were alive in 2005 were sent a self-administered questionnaire, including questions about health status, QOL (MOS SF-36), and fecundity. A standardized fecundity ratio (SFR) was calculated (SFR: observed/expected number of children) for each individual based on a national reference.
Of the 972 individuals (82%) who responded, 53% had at least 1 child. The overall SFR, 0.65, was dependent upon the initial diagnosis, more decreased in Central Nervous System tumors (0.24; p < 10) than in Germ cell (0.46; p = 0.03) or Sympathetic Nervous System tumors (0.79; p = 0.02). The average QOL motor score was 72.5 ± 19.5, and the average mental score was 61.4 ± 16.7. After adjusting for age, pathology, and self-reported sequelae in the questionnaires, it was determined that SF-36 mental (p = 0.002) and motor (p < 0.0002) scores correlated positively with fecundity, and SF-36 scores correlated negatively with locomotor late effects (p < 0.0001), growth insufficiency (p = 0.002), and psychological disorders (p < 0.001). Gonadal insufficiency was correlated with neither motor nor mental scores.
Women treated for childhood cancer demonstrated impaired fecundity that correlated with poor QOL, as registered by the SF-36. Patients should be warned of the risk of impaired fecundity early during the follow-up. If possible, preservation of fertility should be prioritized at initiation of therapy.
描述儿童癌症女性幸存者的生育能力，并考虑与生活质量（QOL）的相关性。
在 1948 年至 1992 年间，8 个法国癌症治疗中心的 1744 名 15 岁以下的儿童癌症患者中，有 1187 名幸存者在 2005 年存活并收到了一份自我管理的问卷，其中包括关于健康状况、QOL（MOS SF-36）和生育能力的问题。根据国家参考值，为每个个体计算了标准化生育力比（SFR）（SFR：观察到的/预期的儿童数量）。
在 972 名（82%）回答的个体中，53%至少有 1 个孩子。总体 SFR 为 0.65，取决于初始诊断，中枢神经系统肿瘤（0.24；p<10）的降低幅度大于生殖细胞（0.46；p=0.03）或交感神经系统肿瘤（0.79；p=0.02）。平均 QOL 运动评分 72.5±19.5，平均心理评分 61.4±16.7。在校正问卷中的年龄、病理和自我报告后遗症后，发现 SF-36 心理（p=0.002）和运动（p<0.0002）评分与生育力呈正相关，SF-36 评分与运动迟发性效应（p<0.0001）、生长不足（p=0.002）和心理障碍（p<0.001）呈负相关。性腺功能不足与运动和心理评分均无关。
接受儿童癌症治疗的女性表现出生育能力受损，这与 SF-36 登记的 QOL 差相关。在随访早期，应警告患者生育能力受损的风险。如果可能，在开始治疗时应优先考虑保留生育能力。
