Byrne J, Mulvihill J J, Myers M H, Connelly R R, Naughton M D, Krauss M R, Steinhorn S C, Hassinger D D, Austin D F, Bragg K
Clinical Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892.
N Engl J Med. 1987 Nov 19;317(21):1315-21. doi: 10.1056/NEJM198711193172104.
In a retrospective cohort study of survivors of cancer and of controls, we estimated the risk of infertility after treatment for cancer during childhood or adolescence. We interviewed 2283 long-term survivors of childhood or adolescent cancer diagnosed in the period from 1945 through 1975, who were identified at five cancer centers in the United States. Requirements for admission to the study were diagnosis before the age of 20, survival for at least five years, and attainment of the age of 21. In addition, 3270 controls selected from among the survivors' siblings were interviewed. Cox regression analysis showed that cancer survivors who married and were presumed to be at risk of pregnancy were less likely than their sibling controls to have ever begun a pregnancy (relative fertility, 0.85; 95 percent confidence interval, 0.78 to 0.92). Radiation therapy directed below the diaphragm depressed fertility in both sexes by about 25 percent. Chemotherapy with alkylating agents, with or without radiation to sites below the diaphragm, was associated with a fertility deficit of about 60 percent in the men. Among the women, there was no apparent effect of alkylating-agent therapy administered alone (relative fertility, 1.02) and only a moderate fertility deficit when alkylating-agent therapy was combined with radiation below the diaphragm (relative fertility, 0.81). Relative fertility in the survivors varied considerably according to sex, site of cancer, and type of treatment; these factors should be taken into consideration in counseling survivors about the long-term consequences of disease.
在一项针对癌症幸存者和对照人群的回顾性队列研究中，我们估算了儿童期或青春期癌症治疗后出现不孕不育的风险。我们对1945年至1975年间在美国五个癌症中心确诊的2283名儿童期或青春期癌症长期幸存者进行了访谈。该研究的入选标准为20岁前确诊、存活至少五年且年满21岁。此外，我们还对从幸存者的兄弟姐妹中挑选出的3270名对照者进行了访谈。Cox回归分析显示，已婚且被认为有怀孕风险的癌症幸存者比其作为对照的兄弟姐妹开始怀孕的可能性更小（相对生育力为0.85；95%置信区间为0.78至0.92）。针对横膈膜以下部位的放射治疗使两性的生育力均降低了约25%。使用烷化剂进行化疗，无论是否对横膈膜以下部位进行放射治疗，男性的生育力均下降约60%。在女性中，单独使用烷化剂治疗没有明显效果（相对生育力为1.02），而当烷化剂治疗与横膈膜以下部位的放射治疗联合使用时，生育力仅有中度下降（相对生育力为0.81）。幸存者的相对生育力因性别、癌症部位和治疗类型的不同而有很大差异；在为幸存者提供有关疾病长期后果的咨询时，应考虑这些因素。
