Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Fred Hutchinson Cancer Center, Seattle, Washington, USA.
Cancer. 2024 Jan 1;130(1):128-139. doi: 10.1002/cncr.34995. Epub 2023 Sep 21.
Treatment exposures for childhood cancer reduce ovarian reserve. However, the success of assisted reproductive technology (ART) among female survivors is not well established.
Five-year survivors of childhood cancer in the Childhood Cancer Survivor Study were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System, which captures national ART outcomes. The authors assessed the live birth rate, the relative risk (RR) with 95% confidence intervals (95% CIs), and associations with treatment exposure using generalized estimating equations to account for multiple ovarian stimulations per individual. Siblings from a random sample of survivors were recruited to serve as a comparison group.
Among 9885 female survivors, 137 (1.4%; median age at diagnosis, 10 years [range, 0-20 years]; median years of follow-up after age 18 years, 11 years [range, 2-11 years]) underwent 224 ovarian stimulations using autologous or donor eggs and/or gestational carriers (157 autologous ovarian stimulation cycles, 67 donor ovarian stimulation cycles). In siblings, 33 (1.4%) underwent 51 autologous or donor ovarian stimulations. Of those who used embryos from autologous eggs without using gestational carriers, 97 survivors underwent 155 stimulations, resulting in 49 live births, for a 31.6% chance of live birth per ovarian stimulation (vs. 38.3% for siblings; p = .39) and a 43.9% chance of live birth per transfer (vs. 50.0%; p = .33). Prior treatment with cranial radiation therapy (RR, 0.44; 95% CI, 0.20-0.97) and pelvic radiation therapy (RR, 0.33; 95% CI, 0.15-0.73) resulted in a reduced chance of live birth compared with siblings. The likelihood of live birth after ART treatment in survivors was not affected by alkylator exposure (cyclophosphamide-equivalent dose, ≥8000 mg/m vs. none; RR, 1.04; 95% CI, 0.52-2.05).
Childhood cancer survivors are as likely to undergo treatment using ART as sibling controls. The success of ART treatment was not reduced after alkylator exposure. The results from the current study provide needed guidance on the use of ART in this population.
儿童癌症的治疗会降低卵巢储备。然而，女性癌症幸存者接受辅助生殖技术（ART）的成功率尚未得到充分证实。
童年癌症幸存者研究中的 5 年幸存者与辅助生殖技术协会诊所结果报告系统相关联，该系统可捕获全国性的 ART 结果。作者使用广义估计方程评估活产率、相对风险（RR）及其与治疗暴露的关联，以考虑个体多次卵巢刺激的情况。从随机抽取的幸存者中招募了兄弟姐妹作为对照组。
在 9885 名女性幸存者中，有 137 名（1.4%；中位诊断年龄为 10 岁[范围 0-20 岁]；18 岁后中位随访年限为 11 年[范围 2-11 年]）接受了 224 次自体或供体卵子和/或代孕者的卵巢刺激治疗（157 次自体卵巢刺激周期，67 次供体卵巢刺激周期）。在兄弟姐妹中，有 33 人（1.4%）接受了 51 次自体或供体卵巢刺激。在未使用代孕者而仅使用自体卵子的胚胎中，有 97 名幸存者接受了 155 次刺激，产生了 49 例活产，每个卵巢刺激周期活产的概率为 31.6%（与兄弟姐妹相比为 38.3%；p=0.39），每个移植周期活产的概率为 43.9%（与兄弟姐妹相比为 50.0%；p=0.33）。与兄弟姐妹相比，接受颅放疗（RR，0.44；95%CI，0.20-0.97）和盆腔放疗（RR，0.33；95%CI，0.15-0.73）的幸存者活产的可能性降低。ART 治疗后幸存者活产的可能性不受烷化剂暴露的影响（环磷酰胺等效剂量≥8000mg/m 与无暴露；RR，1.04；95%CI，0.52-2.05）。
儿童癌症幸存者接受 ART 治疗的可能性与兄弟姐妹对照组相当。烷化剂暴露后，ART 治疗的成功率并未降低。本研究的结果为该人群使用 ART 提供了必要的指导。
