Gerstl Brigitte, Sullivan Elizabeth, Chong Serena, Chia Debbie, Wand Handan, Anazodo Antoinette
1 Department of Biostatistics, The Kirby Institute, University of New South Wales , Kensington, Australia .
2 Kids Cancer Centre, Sydney Children's Hospital , Sydney, Australia .
J Adolesc Young Adult Oncol. 2018 Nov 16. doi: 10.1089/jayao.2018.0036.
Improvements in cancer therapy for childhood and adolescent and young adult (AYA) survivors have increased in excess of 80% among pediatric patients and in excess of 85% among AYA cancer patients. Our research group explored the late effects consequences of cancer treatment on pregnancy and birth outcomes subsequent to a childhood (0-14 years) or AYA (15-25 years) diagnosis of cancer in female cancer survivors. Embase and Medline databases were searched. There were 17 review (n = 10 matched and n = 7 unmatched) studies that met the inclusion criteria. Subanalyses were conducted on 10 matched studies. The median age for all studies for patients at diagnosis and birth was 11 and 27 years, respectively. In matched cohort studies, female childhood and AYA cancer patients, who received chemotherapy alone, had a pooled estimated rate of 18% of experiencing a live birth compared with 10% of females who received radiotherapy alone and subsequently had a live birth. Females who received surgery alone reported higher pooled estimated rates of 44% for a live birth. For matched retrospective review studies, 79% (n = 973) of women experienced a live birth, of which 22% of these babies were born preterm. This meta-analysis found lower birth rates for survivors. Access to fertility-related information and discussions around fertility preservation options and oncofertility psychosocial support should be offered to all cancer patients and their families before starting cancer treatment.
儿童、青少年和青年成人（AYA）癌症幸存者的癌症治疗改善情况在儿科患者中超过了80%，在AYA癌症患者中超过了85%。我们的研究小组探讨了女性癌症幸存者在儿童期（0至14岁）或AYA期（15至25岁）被诊断患有癌症后，癌症治疗对妊娠和分娩结局的远期影响。检索了Embase和Medline数据库。有17项综述研究（n = 10项匹配研究和n = 7项非匹配研究）符合纳入标准。对10项匹配研究进行了亚分析。所有研究中患者诊断时和分娩时的中位年龄分别为11岁和27岁。在匹配队列研究中，仅接受化疗的儿童期和AYA期女性癌症患者活产的合并估计率为18%，而仅接受放疗后活产的女性为10%。仅接受手术的女性报告的活产合并估计率更高，为44%。对于匹配的回顾性综述研究，79%（n = 973）的女性活产，其中22%的婴儿早产。这项荟萃分析发现幸存者的出生率较低。在开始癌症治疗前，应向所有癌症患者及其家属提供与生育相关的信息，以及围绕生育力保存选择和生殖肿瘤心理社会支持的讨论。
