Hospices Civils de Lyon, Hôpital Mère Enfant, Service de Médecine de la Reproduction, Bron, France.
Université Claude Bernard, Faculté de Médecine Laennec, Lyon Cedex 08, France.
Cytopathology. 2023 Mar;34(2):146-153. doi: 10.1111/cyt.13194. Epub 2022 Dec 19.
Patients scheduled to receive chemotherapy should be counselled on fertility preservation. Known gonadotoxic chemotherapies such as alkylating agents have a high risk of altering ovarian reserve. In some cases, the urgency of treatment requires the use of chemotherapy before fertility preservation, which will be carried out at a later stage. Usually the ovarian tissue is cryopreserved. The aim of our study is to investigate the impact of chemotherapies on follicular density and the apoptosis of reserve follicles.
We included 140 patients: 63 patients, mean age 18.8 years, were included in the group "no chemotherapy" (group A) and 77 patients, mean age 17.1 years, in the group "received chemotherapy before ovarian conservation" (group B). None of the patients had had pelvic radiotherapy prior to ovarian cryopreservation. The histological parameters studied were follicular density and the presence of malignant cells. We selected 12 patients from group A and 15 patients from group B, comparable in age and pathology, for whom we evaluated follicle apoptosis by immunostaining cleaved caspase-3.
We demonstrated an inverse relationship between follicular density and age (p < 0.0001), as well as a lack of effect of chemotherapy on follicular density (p = 0.87). We showed the impact of various chemotherapies, especially with alkylating agents, on the apoptosis of ovarian follicles (p < 0.0001). Three patients had ovarian tissue infiltration, two of which were malignant.
This work underlines the fact that conservation of ovarian tissue after chemotherapy remains possible.
接受化疗的患者应接受生育力保存咨询。已知的性腺毒性化疗药物（如烷化剂）具有改变卵巢储备功能的高风险。在某些情况下，治疗的紧迫性需要在生育力保存之前使用化疗，这将在以后进行。通常，卵巢组织被冷冻保存。我们研究的目的是研究化疗对卵泡密度和储备卵泡凋亡的影响。
我们纳入了 140 名患者：63 名患者，平均年龄为 18.8 岁，被纳入“无化疗”组（A 组），77 名患者，平均年龄为 17.1 岁，被纳入“化疗前卵巢保护”组（B 组）。在卵巢冷冻保存之前，没有患者接受过盆腔放疗。研究的组织学参数是卵泡密度和恶性细胞的存在。我们从 A 组中选择了 12 名患者，从 B 组中选择了 15 名年龄和病理相似的患者，通过免疫染色检测 cleaved caspase-3 评估卵泡凋亡。
我们证明了卵泡密度与年龄之间存在负相关（p<0.0001），并且化疗对卵泡密度没有影响（p=0.87）。我们显示了各种化疗药物，特别是烷化剂，对卵巢卵泡凋亡的影响（p<0.0001）。有 3 名患者的卵巢组织有浸润，其中 2 名是恶性的。
这项工作强调了化疗后卵巢组织保存仍然是可能的事实。
