促性腺激素释放激素激动剂对接受铂类化疗的年轻卵巢恶性肿瘤患者卵巢功能的保护作用：一项前瞻性研究。
Gonadotropin-releasing hormone agonist protects ovarian function in young patients with ovarian malignancy undergoing platinum-based chemotherapy: A prospective study.
作者信息
Xie Ya, Duan Haoran, Wang Dong, Li Huiqing, Jia Jia, Zhang Jialin, Li Linlin
机构信息
Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Obstetrics and Gynecology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
出版信息
Front Oncol. 2022 Oct 19;12:986208. doi: 10.3389/fonc.2022.986208. eCollection 2022.
PURPOSE
We aimed to ascertain the effectiveness of gonadotropin-releasing hormone (GnRH) agonist co-therapy for the preservation of ovarian function in patients with ovarian malignancy who underwent unilateral salpingo-oophorectomy and platinum-based chemotherapy.
METHODS
We enrolled 158 patients with ovarian malignancy who underwent fertility preservation surgery and postoperative platinum-based chemotherapy between January 2018 and December 2020. Patients were divided into two groups based on the use of GnRH agonist (GnRHa) during chemotherapy. Two patients withdrew from the study. Laboratory tests (serum follicle-stimulating hormone [FSH], serum luteinizing hormone [LH], and serum anti-Müllerian hormone [AMH]) were performed pre-chemotherapy and one year post-chemotherapy. Data on menstruation resumption, perimenopausal symptoms (modified Kupperman Menopausal Index [KMI]), health-related quality of life (Medical Outcomes Study Short Form-36 [MOS SF-36]), and obstetric outcomes were collected.
RESULTS
One year post-chemotherapy, the serum AMH level in the GnRHa group was higher than that in the control group (P<0.001), while the serum FSH and FSH/LH levels in the GnRHa group were lower than those in the control group (P<0.001). The mean period from last chemotherapy to menstrual resumption was 3.86 and 5.78 months in the GnRHa and control groups (P<0.001), respectively. The rate of menstrual resumption post-chemotherapy was 93.5% and 82.3% in the GnRHa and control groups (P<0.05), respectively. GnRHa co-administration during chemotherapy reduced the likelihood of low AMH levels post-chemotherapy and was significant in the multivariate analysis (P<0.05). The modified KMI scores and MOS SF-36 scores were better in the GnRHa group than in the control group (both P<0.001).
CONCLUSION
GnRHa protects ovarian function during platinum-based adjuvant chemotherapy in young patients with ovarian malignancy. This study provides a therapeutic reference for gynecologists, especially for those in economically and medically underdeveloped areas.
TRIAL REGISTRATION
Chinese Clinical Trial Registry (chiCTR1800019114; October 26, 2018; http://www.chictr.org.cn/index.aspx).
目的
我们旨在确定促性腺激素释放激素（GnRH）激动剂联合治疗对接受单侧输卵管卵巢切除术和铂类化疗的卵巢恶性肿瘤患者卵巢功能的保护作用。
方法
我们纳入了158例在2018年1月至2020年12月期间接受了生育力保留手术及术后铂类化疗的卵巢恶性肿瘤患者。根据化疗期间是否使用GnRH激动剂（GnRHa）将患者分为两组。两名患者退出研究。在化疗前及化疗后一年进行实验室检查（血清卵泡刺激素[FSH]、血清黄体生成素[LH]和血清抗苗勒管激素[AMH]）。收集月经恢复情况、围绝经期症状（改良Kupperman绝经指数[KMI]）、健康相关生活质量（医学结局研究简表36[MOS SF - 36]）及产科结局的数据。
结果
化疗后一年，GnRHa组血清AMH水平高于对照组（P<0.001），而GnRHa组血清FSH及FSH/LH水平低于对照组（P<0.001）。GnRHa组和对照组从末次化疗至月经恢复的平均时间分别为3.86个月和5.78个月（P<0.001）。化疗后月经恢复率在GnRHa组和对照组分别为93.5%和82.3%（P<0.05）。化疗期间联合使用GnRHa降低了化疗后AMH水平低的可能性，在多因素分析中具有显著性（P<0.05）。GnRHa组的改良KMI评分和MOS SF - 36评分均优于对照组（均P<0.001）。
结论
GnRHa可在年轻卵巢恶性肿瘤患者接受铂类辅助化疗期间保护卵巢功能。本研究为妇科医生，尤其是经济和医疗欠发达地区的妇科医生提供了治疗参考。
试验注册
中国临床试验注册中心（chiCTR1800019114；2018年10月26日；http://www.chictr.org.cn/index.aspx）
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