1 Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.
J Womens Health (Larchmt). 2019 Apr;28(4):544-550. doi: 10.1089/jwh.2018.6986. Epub 2018 Jul 2.
In the last decades, long-term outcomes of breast cancer (BC) patients have improved, raising new survivorship issues, including fertility preservation and safety of pregnancy after BC. This study assesses evolution in patterns of fertility discussion/preservation over time and reports pregnancy outcomes in a cohort of young BC patients.
A retrospective cohort of 590 BC patients aged ≤40 diagnosed between 2000 and 2016 at a large cancer center was identified. Fertility counseling and preservation patterns for patients receiving chemotherapy were analyzed and compared for two cohorts: 2004-2006 and 2014-2016 (total n = 161). Outcomes were reported for patients with documented pregnancy after BC.
Significantly, more patients diagnosed in 2014-2016 had evidence of discussion on fertility issues and/or application of fertility preservation techniques versus patients diagnosed in 2004-2006 (82.9% vs. 66.0%, p = 0.017). In particular, there was a significant difference in rate of documented fertility issues discussion (67.6% vs. 34.0%, p < 0.001). Age >35 and parity were associated with lower rates of fertility discussion/preservation. However, rates significantly improved over time (77.6% in 2014-2016 vs. 58.1% in 2004-2006 for patients aged >35, p = 0.046; 80.7% in 2014-2016 vs. 57.6% in 2004-2006 for patients with children at diagnosis, p = 0.018). Twenty-six patients with pregnancy after BC were identified; eight delivered at the age of >40. No complications for women or newborns were reported. Only two patients experienced BC relapse.
In this small retrospective cohort, no safety concerns were identified for pregnancy after BC. The importance attributed by clinicians to address fertility issues has increased over time.
在过去几十年中，乳腺癌（BC）患者的长期预后得到了改善，由此产生了新的生存问题，包括生育力保存和 BC 后妊娠的安全性。本研究评估了随着时间的推移，生育讨论/保存模式的演变，并报告了一组年轻 BC 患者的妊娠结局。
回顾性分析了 2000 年至 2016 年在一家大型癌症中心诊断为 ≤40 岁的 590 例 BC 患者的队列。对接受化疗的患者的生育咨询和保存模式进行了分析，并比较了 2004-2006 年和 2014-2016 年的两个队列（总 n=161）。报告了有记录的 BC 后妊娠患者的结局。
2014-2016 年诊断的患者明显比 2004-2006 年诊断的患者更多地讨论生育问题和/或应用生育力保存技术（82.9% vs. 66.0%，p=0.017）。特别是，有记录的生育问题讨论率有显著差异（67.6% vs. 34.0%，p<0.001）。年龄>35 岁和生育史与生育讨论/保存的比例较低相关。然而，随着时间的推移，这些比率显著提高（2014-2016 年年龄>35 岁的患者为 77.6%，2004-2006 年为 58.1%，p=0.046；2014-2016 年有子女的患者为 80.7%，2004-2006 年为 57.6%，p=0.018）。确定了 26 例 BC 后妊娠的患者，8 例在年龄>40 岁时分娩。未报告母婴并发症。仅 2 例患者出现 BC 复发。
在本小型回顾性队列中，BC 后妊娠无安全性问题。随着时间的推移，临床医生对解决生育问题的重视程度有所提高。
