Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy.
Reprod Biomed Online. 2020 Jul;41(1):96-112. doi: 10.1016/j.rbmo.2020.02.008. Epub 2020 Feb 22.
Data on the effects of cancer treatments on fertility are conflicting. The aim of the present systematic review and meta-analysis was to determine the chances of childbirth in women survivors of different types of cancer. PubMed, MEDLINE, Embase and Scopus were searched from database inception to 17 July 2019 for published cohort, case-control and cross-sectional studies that investigated the reproductive chances in women survivors of different cancer types. Random-effects models were used to pool childbirth hazard ratios, relative risks, rate ratios and odds ratios, and 95% confidence intervals were estimated; 18 eligible studies were identified. Childbirth chances were significantly reduced in women with a history of bone cancer (HR 0.86, 95% CI 0.77 to 0.97; I = 0%; P = 0.02 (two studies); RaR 0.76, 95% CI 0.61 to 0.95; I = 69%; P = 0.01 (two studies); breast cancer (HR 0.74, 95% CI 0.61 to 0.90 (one study); RaR 0.51, 95% CI 0.47 to 0.57; I = 0%; P < 0.00001 (two studies); brain cancer (HR 0.61, 95% CI 0.51 to 0.72; I = 14%; P < 0.00001 (three studies); RR 0.62, 95% CI 0.42 to 0.91 (one study); RaR 0.44, 95% CI 0.33 to 0.60; I = 95%; P < 0.00001 (four studies); OR 0.49, 95% CI 0.40 to 0.60 (one study); and kidney cancer (RR 0.66, 95% CI 0.43 to 0.98 (one study); RaR 0.69, 95% CI 0.61 to 0.78 (one study). Reproductive chances in women survivors of non-Hodgkin's lymphoma, melanoma and thyroid cancer were unaffected. Women with a history of bone, breast, brain or kidney cancer have reduced chances of childbirth. Thyroid cancer, melanoma and non-Hodgkin's lymphoma survivors can be reassured.
关于癌症治疗对生育力影响的数据相互矛盾。本系统评价和荟萃分析的目的是确定不同类型癌症女性幸存者的生育机会。从数据库建立到 2019 年 7 月 17 日，在 PubMed、MEDLINE、Embase 和 Scopus 上搜索了调查不同癌症类型女性幸存者生殖机会的已发表队列、病例对照和横断面研究。使用随机效应模型汇总生育危害比、相对风险、率比和优势比，并估计 95%置信区间；确定了 18 项合格的研究。患有骨癌（HR 0.86，95%CI 0.77 至 0.97；I=0%；P=0.02（两项研究）；RaR 0.76，95%CI 0.61 至 0.95；I=69%；P=0.01（两项研究）；乳腺癌（HR 0.74，95%CI 0.61 至 0.90（一项研究）；RaR 0.51，95%CI 0.47 至 0.57；I=0%；P<0.00001（两项研究）；脑癌（HR 0.61，95%CI 0.51 至 0.72；I=14%；P<0.00001（三项研究）；RR 0.62，95%CI 0.42 至 0.91（一项研究）；RaR 0.44，95%CI 0.33 至 0.60；I=95%；P<0.00001（四项研究）；OR 0.49，95%CI 0.40 至 0.60（一项研究）；和肾癌（RR 0.66，95%CI 0.43 至 0.98（一项研究）；RaR 0.69，95%CI 0.61 至 0.78（一项研究）。非霍奇金淋巴瘤、黑色素瘤和甲状腺癌女性幸存者的生育机会不受影响。患有骨癌、乳腺癌、脑癌或肾癌的女性生育机会降低。可以让甲状腺癌、黑色素瘤和非霍奇金淋巴瘤的幸存者放心。
