基于化疗的性腺毒性风险评估作为青春期后患者卵巢组织冷冻保存后生殖结局的预测指标。
Chemotherapy-based gonadotoxicity risk evaluation as a predictor of reproductive outcomes in post-pubertal patients following ovarian tissue cryopreservation.
作者信息
Karavani Gilad, Rottenstreich Amihai, Schachter-Safrai Natali, Cohen Adiel, Weintraub Michael, Imbar Tal, Revel Ariel
机构信息
Department of Obstetrics and Gynecology, Hadassah Ein-Kerem Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
出版信息
BMC Womens Health. 2021 May 13;21(1):201. doi: 10.1186/s12905-021-01343-z.
BACKGROUND
The sterilizing effect of cancer treatment depends mostly on the chemotherapy regimen and extent of radiotherapy. Prediction of long-term reproductive outcomes among cancer survivors according to chemo-radiotherapy regimen may improve pre-treatment fertility preservation counseling and future reproductive outcomes.
METHODS
The aim of this study was to evaluate long term reproductive outcomes in cancer survivors according to gonadotoxicity risk estimation of the chemo-radiotherapy regimens utilized. This retrospective cohort study was comprised of post-pubertal female patients referred for fertility preservation during 1997 and 2017 was performed. Eligible adult patients were addressed and asked to complete a clinical survey regarding their ovarian function, menstruation, reproductive experience and ovarian tissue auto-transplantation procedures. Results were stratified according to the gonadotoxic potential of chemotherapy and radiotherapy they received-low, moderate and high-risk, defined by the regimen used, the cumulative dose of chemotherapy administered and radiation therapy extent.
RESULTS
A total of 120 patients were eligible for the survey. Of those, 92 patients agreed to answer the questionnaire. Data regarding chemotherapy regimen were available for 77 of the 92 patients who answered the questionnaire. Menopause symptoms were much more prevalent in patients undergoing high vs moderate and low-risk chemotherapy protocol. (51.4% vs. 27.3% and 16.7%, respectively; p < 0.05). Spontaneous pregnancy rates were also significantly lower in the high-risk compared with the low-risk gonadotoxicity regimen group (32.0% vs. 58.3% and 87.5%, respectively; p < 0.05).
CONCLUSION
Patients scheduled for aggressive cancer treatment have significantly higher rates of menopause symptoms and more than double the risk of struggling to conceive spontaneously. Improving prediction of future reproductive outcomes according to treatment protocol and counseling in early stages of cancer diagnosis and treatment may contribute to a tailored fertility related consultation among cancer survivors.
背景
癌症治疗的杀菌效果主要取决于化疗方案和放疗范围。根据放化疗方案预测癌症幸存者的长期生殖结局，可能会改善治疗前的生育力保存咨询及未来的生殖结局。
方法
本研究的目的是根据所采用的放化疗方案的性腺毒性风险评估，评估癌症幸存者的长期生殖结局。这项回顾性队列研究纳入了1997年至2017年间因生育力保存而转诊的青春期后女性患者。对符合条件的成年患者进行了调查，并要求她们完成一份关于卵巢功能、月经、生殖经历和卵巢组织自体移植手术的临床调查问卷。结果根据她们接受的化疗和放疗的性腺毒性潜力进行分层——低、中、高风险，这是由所使用的方案、化疗累积剂量和放疗范围定义的。
结果
共有120名患者符合调查条件。其中，92名患者同意回答问卷。在回答问卷的92名患者中，有77名患者提供了化疗方案的数据。与接受中低风险化疗方案的患者相比，接受高风险化疗方案的患者出现绝经症状的情况更为普遍。（分别为51.4%、27.3%和16.7%；p<0.05）。与低风险性腺毒性方案组相比，高风险组的自然妊娠率也显著更低（分别为32.0%、58.3%和87.5%；p<0.05）。
结论
计划接受积极癌症治疗的患者出现绝经症状的几率显著更高，自然受孕困难的风险增加了一倍多。根据治疗方案改善对未来生殖结局的预测，并在癌症诊断和治疗的早期阶段进行咨询，可能有助于为癌症幸存者提供量身定制的生育相关咨询。
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