Pregnancy after chemotherapy in male and female survivors of childhood cancer treated between 1970 and 1999: a report from the Childhood Cancer Survivor Study cohort
Pregnancy after chemotherapy in male and female survivors of childhood cancer treated between 1970 and 1999: a report from the Childhood Cancer Survivor Study cohort
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DOI：
10.1016/s1470-2045(16)00086-3
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发表时间：
2016-05-01
期刊：
影响因子：
51.1
通讯作者：
Green, Daniel M.
中科院分区：
文献类型：
--
作者：
Chow, Eric J.;Stratton, Kayla L.;Green, Daniel M.
背景许多现代化疗药物对妊娠和活产的影响尚未得到很好的证实。我们的目的是确定这些药物对未接受骨盆或颅骨放疗的儿童癌症男性和女性幸存者妊娠的影响。其后，5- 1970年至1999年期间，在21岁之前被诊断出患有最常见类型的儿童癌症并在美国和加拿大的27家机构接受治疗的10岁幸存者。1999.我们从医疗记录中提取了14种烷化剂和类似的DNA链间交联药物的剂量。我们使用性别特异性考克斯模型来建立每种药物的独立效应和所有药物的累积环磷酰胺等效剂量与15岁至44岁之间发生的妊娠和活产的相关性。我们包括幸存者的兄弟姐妹作为一个comparative group.Findings我们包括10 938幸存者和3949兄弟姐妹。从进入队列或15岁时（以较晚者为准）中位随访8年（IQR 4-12）后，4149名（38%）幸存者报告妊娠或怀孕，其中3453名（83%）个体报告至少一次活产。在中位随访10年（IQR 6-15）后，2445（62%）名兄弟姐妹报告怀孕或生子，其中2201（90%）人报告至少有一次活产。在多变量分析中，与兄弟姐妹相比，幸存者的父系或妊娠可能性降低（男性幸存者：风险比[HR] 0.63，95%CI 0.58-0.68; p
Background The effect of many contemporary chemotherapeutic drugs on pregnancy and livebirth is not well established. We aimed to establish the effects of these drugs on pregnancy in male and female survivors of childhood cancer not exposed to pelvic or cranial radiotherapy.Methods We used data from a subset of the Childhood Cancer Survivor Study cohort, which followed 5-year survivors of the most common types of childhood cancer who were diagnosed before age 21 years and treated at 27 institutions in the USA and Canada between 1970 and 1999. We extracted doses of 14 alkylating and similar DNA interstrand crosslinking drugs from medical records. We used sex-specific Cox models to establish the independent effects of each drug and the cumulative cyclophosphamide equivalent dose of all drugs in relation to pregnancies and livebirths occurring between ages 15 years and 44 years. We included siblings of survivors as a comparison group.Findings We included 10 938 survivors and 3949 siblings. After a median follow-up of 8 years (IQR 4-12) from cohort entry or at age 15 years, whichever was later, 4149 (38%) survivors reported having or siring a pregnancy, of whom 3453 (83%) individuals reported at least one livebirth. After a median follow-up of 10 years (IQR 6-15), 2445 (62%) siblings reported having or siring a pregnancy, of whom 2201 (90%) individuals reported at least one livebirth. In multivariable analysis, survivors had a decreased likelihood of siring or having a pregnancy versus siblings (male survivors: hazard ratio [HR] 0.63, 95% CI 0.58-0.68; p