Reproduction Rates After Cancer Treatment: Experience From the Norwegian Radium Hospital
Reproduction Rates After Cancer Treatment: Experience From the Norwegian Radium Hospital
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DOI：
10.1200/jco.2007.15.3130
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发表时间：
2009-01-20
影响因子：
45.3
通讯作者：
Fossa, Sophie Dorothea
中科院分区：
文献类型：
--
作者：
Cvancarova, Milada;Samuelsen, Sven Ove;Fossa, Sophie Dorothea
目的大多数关于癌后生殖的研究都受到患者数量和缺乏对照组的限制。我们计算了 10 年首次诊断后累积再生率 (10-PDR) 和风险比 (HR)，以避免这些限制。 患者和方法 1971 年至 1997 年间接受治疗的 6071 名诊断时年龄为 15 至 45 岁的癌症患者以及来自一般人群的 30,355 名对照（全部出生于 1950 年之后）从真实（患者）或指定（对照）日期开始观察。诊断时间中位数为 10 年（范围：0 至 35）。该研究的主要重点是基于挪威医学出生登记处数据的 1988 年以上前后的 10-PDR。 Cox 比例风险回归模型根据诊断时的年龄和日历年进行调整，并按性别和诊断前父母身份进行分层。结果在所有癌症类型中，女性患者的 HR 比对照组低约 50%，男性患者的可比百分比约为 30%，1988 年以后选定的诊断有所改善。在无子女患者中观察到最高的 10-PDR，男性患者的 HR 比女性患者更有利。在诊断时至少有一个孩子的幸存者中，与 1988 年之前相比，1988 年之后的睾丸癌和局限性宫颈癌患者的 HR 显着改善，局部卵巢癌的生育率略有改善。结论癌症后的生育率低于一般人群，并受到性别、诊断时年龄、诊断前为人父母和诊断时期的影响，男性的生育率优于女性。 1988 年以后的生育策略可能提高了某些生殖器癌症的繁殖率。
PurposeMost studies on postcancer reproduction are limited in patient numbers and lack of control group. We have computed 10-year first postdiagnosis cumulative reproduction rates (10-PDRs) and hazard ratios (HRs) avoiding these limitations.Patients and MethodsSix thousand seventy-one patients with cancer age 15 to 45 years at diagnosis, treated from 1971 to 1997, and 30,355 controls from the general population, all born after 1950, were observed from the true (patients) or assigned (controls) date of diagnosis for a median of 10 years (range, 0 to 35). The primary focus of the study was the 10-PDR before and after 1988+ based on data from the Medical Birth Registry of Norway. Cox proportional hazards regression models were adjusted for age and calendar year at diagnosis, stratified by sex and prediagnosis parenthood.ResultsAcross all cancer types, HRs of females were approximately 50% lower than those of the controls, the comparable percentage for male patients being approximately 30%, with some improvement after 1988+ for selected diagnoses. The highest 10-PDRs were observed in childless patients, with more favorable HRs in male than in female patients. In survivors with at least one child at diagnosis, the post-1988+ HRs improved significantly in patients with testicular and localized cervical cancer compared to pre-1988+ reproduction, with borderline improvement in localized ovarian cancer.ConclusionPostcancer reproduction is lower than that of the general population and influenced by sex, age at diagnosis, prediagnosis parenthood, and diagnostic period with more favorable rates in males than in females. Post-1988+ fertility-saving strategies may have improved the reproduction rates for select genital cancers.