Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut; the Department of Gynecological Oncology, Yozgat State Hospital, Yozgat, Turkey; and the Innovation Institute for Fertility Preservation and IVF, New York, New York, and New Haven, Connecticut.
Obstet Gynecol. 2024 Oct 1;144(4):481-492. doi: 10.1097/AOG.0000000000005708. Epub 2024 Aug 22.
To evaluate the utility, success, and safety of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for fertility preservation in patients with gynecologic cancers.
A comprehensive search was performed of the MEDLINE, EMBASE, ClinicalTrials.gov , and Cochrane Library databases to identify relevant studies on the utility and outcomes of ovarian tissue cryopreservation and autologous cryopreserved ovarian tissue transplantation for gynecologic cancers from inception until January 23, 2024.
Two reviewers independently performed the study selection, data extraction, and risk-of-bias assessment, and the results were then reviewed together. Twenty-three studies were included in the current systematic review.
TABULATION, INTEGRATION, AND RESULTS: The resultant data were meta-analyzed to produce a pooled-effect estimate of the utility of ovarian tissue cryopreservation and autologous transplantation in gynecologic cancers as a proportion of all indications. We found that 7.5% and 9.6% of women undergoing ovarian tissue cryopreservation and autologous transplantation, respectively, had gynecologic cancers. In comparison, hematologic malignancies and breast cancer accounted for approximately 66.0% of all indications for these procedures. The return rate for autologous cryopreserved ovarian tissue transplantation in gynecologic cancers (6.0%) was not statistically different from those for other indications. Among women with gynecologic cancer who underwent ovarian stimulation, 27.3% had at least one child, and the ovarian endocrine function was restored in 78.1% of the women after autologous transplantation. The median graft longevity was 32 months, and no graft-site recurrence was reported after autologous transplantation in women with gynecologic cancer.
Our results suggest that ovarian tissue cryopreservation and autologous transplantation are feasible options for preserving ovarian function in women with gynecologic cancers, although ovarian tissue cryopreservation is underutilized, and further studies are needed to determine the longer-term outcomes of autologous transplantation.
PROSPERO, CRD42024498522.
评估妇科癌症患者进行卵巢组织冷冻保存和自体冷冻保存卵巢组织移植以保留生育力的效用、成功率和安全性。
全面检索 MEDLINE、EMBASE、ClinicalTrials.gov 和 Cochrane Library 数据库，以确定自成立至 2024 年 1 月 23 日关于妇科癌症卵巢组织冷冻保存和自体冷冻保存卵巢组织移植的效用和结果的相关研究。
两名审查员独立进行研究选择、数据提取和偏倚风险评估，然后共同审查结果。本系统评价共纳入 23 项研究。
列表、综合和结果：对数据进行荟萃分析，以产生卵巢组织冷冻保存和自体移植在妇科癌症中的效用的汇总效应估计，作为所有适应症的比例。我们发现，分别有 7.5%和 9.6%接受卵巢组织冷冻保存和自体移植的女性患有妇科癌症。相比之下，血液系统恶性肿瘤和乳腺癌约占这些手术所有适应症的 66.0%。妇科癌症中自体冷冻保存卵巢组织移植的返回率（6.0%）与其他适应症无统计学差异。在接受卵巢刺激的妇科癌症女性中，27.3%至少有一个孩子，78.1%的女性在自体移植后卵巢内分泌功能得到恢复。移植的中位移植物寿命为 32 个月，在妇科癌症女性中自体移植后未报告移植物部位复发。
我们的结果表明，卵巢组织冷冻保存和自体移植是保留妇科癌症女性卵巢功能的可行选择，尽管卵巢组织冷冻保存的利用率较低，需要进一步研究来确定自体移植的长期结果。
PROSPERO，CRD42024498522。
