Spontaneous abortion in a Danish population-based cohort of childhood cancer survivors
Spontaneous abortion in a Danish population-based cohort of childhood cancer survivors
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DOI：
10.1200/jco.2007.15.2884
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发表时间：
2008-09-10
影响因子：
45.3
通讯作者：
Olsen, Jorgen H.
中科院分区：
文献类型：
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作者：
Winther, Jeanette F.;Boice, John D., Jr.;Olsen, Jorgen H.
目的辐射会诱导实验动物发生生殖细胞突变，导致不良妊娠结局，高剂量放射治疗也会造成子宫损伤。我们评估了接受放射治疗并随后怀孕的癌症幸存者中自然流产和死产的风险。患者和方法我们在丹麦癌症登记处确定了 1,688 名儿童癌症女性幸存者。卵巢和子宫的辐射剂量按从高到低的顺序排列。从全国登记处确定了幸存者、2,737 名姐妹和 16,700 名对照妇女的妊娠结局。将幸存者中导致活产、死产或流产的妊娠比例与两个对照组的同等比例进行比较，并以姐妹为参照计算比例比 (PR)。 结果 评估了超过 34,000 例妊娠，其中 1,479 例为癌症幸存者。幸存者和对照妇女之间的活产、死产或所有类型流产的比例没有显着差异。然而，幸存者自然流产的风险高出 23%（PR，1.23；95% CI，1.0 至 1.5），主要与之前的放射治疗（PR，1.58；95% CI，1.2 至 2.2）有关，特别是与卵巢和子宫的高剂量放射治疗（PR，2.8；95% CI，1.7 至 2.2）有关。 4.7).结论幸存者的妊娠结局与对照妇女相似。自然流产的风险稍高可能是由于高剂量盆腔放疗后子宫损伤造成的，这与之前的研究一致，尽管不能排除辐射引起的生发突变或下丘脑-垂体-卵巢功能下降。
PurposeRadiation induces germ-cell mutations in experimental animals that result in adverse pregnancy outcomes, as does uterine damage caused by high-dose radiotherapy. We assessed the risks for spontaneous abortion and stillbirths among cancer survivors who received radiotherapy and subsequently became pregnant.Patients and MethodsWe identified 1,688 female survivors of childhood cancer in the Danish Cancer Registry. Radiation doses to the ovary and uterus were characterized as high to low. The pregnancy outcomes of survivors, 2,737 sisters, and 16,700 comparison women in the population were identified from nationwide registries. The proportions of pregnancies among survivors that resulted in a livebirth, stillbirth, or abortion were compared with the equivalent proportions among the two comparison groups, and proportion ratios (PRs) were computed with sisters as referent.ResultsMore than 34,000 pregnancies were evaluated, 1,479 of which were among cancer survivors. No significant differences were seen between survivors and comparison women in the proportions of livebirths, stillbirths, or all types of abortions combined. Survivors, however, had a 23% excess risk for spontaneous abortion (PR, 1.23; 95% CI, 1.0 to 1.5), related primarily to prior radiation treatments (PR, 1.58; 95% CI, 1.2 to 2.2) and especially high-dose radiotherapy to the ovaries and uterus (PR, 2.8; 95% CI, 1.7 to 4.7).ConclusionThe pregnancy outcomes of survivors were similar to those of comparison women. A slight excess risk for spontaneous abortion may have resulted from uterine damage after high-dose pelvic radiotherapy, consistent with previous studies, although radiation-induced germinal mutations or decreased hypothalamic-pituitary-ovarian function could not be ruled out.