Department of Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, MI, 48109, USA.
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
Breast Cancer Res Treat. 2021 Apr;186(2):429-437. doi: 10.1007/s10549-020-06031-4. Epub 2021 Jan 4.
Breast cancer is the most common cancer in reproductive age women, and treatment can affect fertility; however, there is often concern regarding the safety of increased estradiol (E) levels and potential delays in treatment with ovarian stimulation for fertility preservation (FP). The aim of this study was to compare recurrence and survival in breast cancer patients who pursued FP without concurrent letrozole to those who did not (non-FP).
We reviewed charts of women with breast cancer who contacted the FP patient navigator (PN) at Northwestern University from 01/2005-01/2018. Oncology and fertility outcome data were collected. Data were analyzed by Chi-square test or regression, as appropriate. Kaplan-Meier curves were used to examine breast cancer recurrence and survival. Statistical analyses were performed with SPSS IBM Statistics 26.0 for Windows.
332 patients were included, of which 157 (47.3%) underwent FP. Median days to treatment after consulting the PN was 35 in the FP group and 21 in non-FP (p < 0.05). Cancer recurrence was noted in 7 (4.7%) FP patients and 13 (7.9%) non-FP patients (NS), and mortality in 5 (3.2%) FP patients and 7 (4.2%) non-FP patients (NS). Within the FP group, no significant differences were found in recurrence or mortality based on ER status, age, BMI, peak E level or total gonadotropin dose. Likelihood of pursuing FP was primarily a function of age and parity, and was not affected by breast cancer stage. To date, 21 have used cryopreserved specimens, and 13 (62%) had a live birth.
FP is safe and effective in breast cancer patients, regardless of receptor status; E elevations and the 2-week delay in treatment start are unlikely to be clinically significant. These findings are unique in that our institution does not use concomitant letrozole during stimulation to minimize E elevations in breast cancer patients.
乳腺癌是生育期女性最常见的癌症，其治疗可能会影响生育能力；然而，人们常常担心增加雌二醇（E）水平的安全性以及为了生育保存（FP）而进行卵巢刺激治疗的潜在延迟。本研究的目的是比较接受 FP 治疗但未同时使用来曲唑的乳腺癌患者与未接受 FP 治疗的患者（非 FP 组）的复发和生存情况。
我们回顾了 2005 年 1 月至 2018 年 1 月期间联系西北大学 FP 患者导航员的乳腺癌患者的病历。收集肿瘤学和生育结局数据。采用卡方检验或回归分析，适当情况下采用 Kaplan-Meier 曲线来检查乳腺癌复发和生存情况。统计分析采用 SPSS IBM Statistics 26.0 for Windows 进行。
共纳入 332 例患者，其中 157 例（47.3%）接受 FP 治疗。在 FP 组中，咨询 PN 后开始治疗的中位天数为 35 天，而非 FP 组为 21 天（p<0.05）。FP 组中有 7 例（4.7%）患者出现癌症复发，而非 FP 组中有 13 例（7.9%）患者出现癌症复发（无统计学差异），FP 组中有 5 例（3.2%）患者死亡，而非 FP 组中有 7 例（4.2%）患者死亡（无统计学差异）。在 FP 组中，ER 状态、年龄、BMI、峰值 E 水平或总促性腺激素剂量与复发或死亡率无显著差异。FP 的可能性主要取决于年龄和产次，与乳腺癌分期无关。迄今为止，有 21 人使用了冷冻保存的标本，其中 13 人（62%）有活产。
无论受体状态如何，FP 在乳腺癌患者中是安全有效的；E 升高和治疗开始延迟两周不太可能具有临床意义。这些发现是独特的，因为我们机构在刺激期间不使用来曲唑来降低乳腺癌患者的 E 升高。
