Acute ovarian failure in the childhood cancer survivor study
Acute ovarian failure in the childhood cancer survivor study
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DOI：
10.1210/jc.2006-0020
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发表时间：
2006-05-01
影响因子：
5.8
通讯作者：
Sklar, CA
中科院分区：
文献类型：
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作者：
Chemaitilly, W;Mertens, AC;Sklar, CA
背景：急性卵巢功能衰竭 (AOF) 定义为诊断后 5 年内卵巢功能丧失，已知部分儿科和青少年癌症幸存者会发生这种情况。其确切的发病率尚不清楚，有关其危险因素的数据也有限。 目的：我们的目的是在大型儿科癌症幸存者队列中确定 AOF 的发生率以及与 AOF 相关的患者/治疗因素。设计和设置：我们进行了一项回顾性队列、多中心研究。患者：考虑纳入儿童癌症幸存者研究中年龄大于 18 岁的女性参与者。我们排除了接受头颅照射剂量超过 3000 cGy 的幸存者、患有下丘脑/垂体肿瘤的幸存者以及接受双侧卵巢切除术的幸存者。报告从未月经或在癌症诊断后 5 年内停止月经的幸存者被认为患有 AOF。主要结果：我们评估了 AOF 的发病率和危险因素。结果：在总共 3390 名符合条件的幸存者中，215 例 (6.3%) 发生了 AOF。与没有 AOF 的幸存者相比，患有 AOF 的幸存者在诊断时年龄较大，并且更有可能被诊断为霍奇金淋巴瘤或接受腹部或盆腔放疗。在 AOF 幸存者中，116 人 (54%) 接受过至少 1000 cGy 的卵巢照射。在多变量逻辑回归模型中，13-20 岁时卵巢照射剂量增加、丙卡巴肼暴露和环磷酰胺暴露是 AOF 的独立危险因素。 结论：一小部分幸存者会发生 AOF，尤其是接受至少 1000 cGy 卵巢放射治疗的患者。这些结果将有助于患者咨询和选择更新的生育力保存技术的候选人。
Context: Defined as the loss of ovarian function within 5 yr of diagnosis, acute ovarian failure (AOF) is known to develop in a subset of survivors of pediatric and adolescent cancers. Its precise incidence is unknown, and data concerning its risk factors are limited.Objective: Our objective was to determine the incidence of and patient/treatment factors associated with AOF in a large cohort of pediatric cancer survivors.Design and Setting: We conducted a retrospective cohort, multicenter study.Patients: Female participants from the Childhood Cancer Survivor Study who were greater than 18 yr of age were considered for inclusion. We excluded survivors who received cranial irradiation at doses of more than 3000 cGy, those with hypothalamic/pituitary tumors, and survivors who underwent bilateral oophorectomy. Survivors who reported never menstruating or who had ceased having menses within 5 yr after their cancer diagnosis were considered to have AOF.Main Outcome: We assessed incidence and risk factors for AOF.Results: Of a total of 3390 eligible survivors, 215 cases (6.3%) developed AOF. Survivors with AOF were older at diagnosis and more likely to have been diagnosed with Hodgkin's lymphoma or to have received abdominal or pelvic radiotherapy than survivors without AOF. Among survivors with AOF, 116 (54%) had received at least 1000-cGy ovarian irradiation. In a multivariable logistic regression model, increasing doses of ovarian irradiation, exposure to procarbazine, and exposure to cyclophosphamide at ages 13-20 yr were independent risk factors for AOF.Conclusions: AOF develops in a small subset of survivors, especially those treated with at least 1000-cGy ovarian radiation. These results will facilitate patient counseling and selection of candidates for newer fertility preservation techniques.