Nonsurgical premature menopause and reproductive implications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.
Nonsurgical premature menopause and reproductive implications in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.
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儿童癌症幸存者的非手术过早绝经和生殖影响：儿童癌症幸存者研究的报告。
DOI：
10.1002/cncr.31121
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发表时间：
2018-03-01
期刊：
影响因子：
6.2
通讯作者：
Sklar CA
中科院分区：
文献类型：
--
作者：
Levine JM;Whitton JA;Ginsberg JP;Green DM;Leisenring WM;Stovall M;Robison LL;Armstrong GT;Sklar CA
儿童癌症的幸存者有非手术性过早绝经（NSPM）的风险。NSPM的风险因素和NSPM对生殖的影响仍然不清楚。1970-1986年诊断的2930名幸存者（中位年龄6岁，范围0-20岁）的月经状态;研究时年龄大于18岁（中位年龄35岁，范围18-58岁）的患者与1399名同胞进行了比较。NSPM定义为40岁之前诊断后月经停止≥ 6个月5年，而不是由于妊娠、手术或药物。在幸存者中，多变量logistic回归确定了NSPM的危险因素。妊娠率和活产率进行了比较，幸存者与无NSPM。110名幸存者发生了NSPM（中位年龄32岁，范围16-40岁），40岁时的患病率为9.1%（95%置信区间[CI] 4.9%-17.2%）;与兄弟姐妹相比，比值比（OR）为10.5（95% CI 4.2-26.3）。独立危险因素包括甲基苄肼暴露≥ 4，000 mg/m2或8.96（95% CI 5.02-16.00），任何剂量的卵巢放疗（OvRT）（OvRT<500 cGy，OR 2.73（95% CI 1.33-5.61）; OvRT ≥500 cGy，OR 8.02（95% CI 2.81-22.85）;参考RT=0），接受干细胞移植OR 6.35（95% CI 1.19-33.93）。与无NSPM的幸存者相比，在31-40岁之间，发生NSPM的患者不太可能怀孕，率比（RR）为0.41（95%CI 0.22-0.68）或活产RR为0.35（95%CI 0.16-0.66）。儿童期癌症的幸存者在30多岁时的活产率较低，有患NSPM的风险。那些有风险的人如果预期推迟生育，应该考虑保留生育能力。
Survivors of childhood cancer are at risk for non-surgical premature menopause (NSPM). Risk factors for NSPM and impact of NSPM on reproduction remain poorly defined. Menopausal status of 2930 survivors diagnosed 1970–1986, (median age 6, range 0–20); older than 18 at study (median age 35, range 18–58) was compared to 1399 siblings. NSPM was defined as menses cessation ≥six months 5 years after diagnosis prior to age 40 not due to pregnancy, surgery or medications. Among survivors, multivariable logistic regression identified risk factors for NSPM. Pregnancy and live birth rates were compared between survivors with and without NSPM. 110 survivors developed NSPM (median age 32, range 16–40), prevalence at age 40 9.1% (95% confidence interval [CI] 4.9%–17.2%); odds ratio (OR) 10.5 (95% CI 4.2–26.3) compared to siblings. Independent risk factors included exposure to procarbazine ≥ 4,000mg/m2 OR 8.96 (95% CI 5.02–16.00), any dose of ovarian radiation (OvRT) (OvRT<500 cGy, OR 2.73 (95% CI 1.33–5.61); OvRT ≥500 cGy, OR 8.02 (95% CI 2.81–22.85); referent RT=0), and receipt of a stem cell transplant OR 6.35 (95% CI 1.19–33.93). Compared to survivors without NSPM, those who developed NSPM were less likely to ever be pregnant, rate ratio (RR) 0.41 (95% CI 0.22–0.68) or have a live birth RR 0.35, (95% CI 0.16–0.66) between ages 31–40. Survivors of childhood cancer are at risk for NSPM associated with lower rates of live birth in their thirties. Those at risk should consider fertility preservation if they anticipate delaying childbearing.
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