Ovarian Failure and Reproductive Outcomes After Childhood Cancer Treatment: Results From the Childhood Cancer Survivor Study
Ovarian Failure and Reproductive Outcomes After Childhood Cancer Treatment: Results From the Childhood Cancer Survivor Study
复制标题
DOI：
10.1200/jco.2008.21.1839
复制
发表时间：
2009-05-10
影响因子：
45.3
通讯作者：
Yasui, Yutaka
中科院分区：
文献类型：
--
作者：
Green, Daniel M.;Sklar, Charles A.;Yasui, Yutaka
这些研究旨在确定儿童或青春期诊断的癌症治疗对卵巢功能和生殖结果的影响（如果有的话）。我们回顾了儿童癌症幸存者研究（CCSS）参与者中急性卵巢功能衰竭、过早绝经、活产、死产、自然流产和治疗性流产以及出生缺陷的频率。急性卵巢功能衰竭（AOF）发生在6.3%的合格幸存者。卵巢暴露于高剂量辐射（特别是超过10戈伊），烷化剂和甲基苄肼，在老年人，是AOF的重要危险因素。非手术性过早绝经（PM）发生在8%的参与者和0.8%的兄弟姐妹中（率比= 13.21; 95%CI，3.26 - 53.51; P <0.001）。PM的危险因素包括达到年龄，暴露于增加剂量的卵巢辐射，增加烷化剂评分，并诊断为霍奇金淋巴瘤。1227名男性幸存者报告说他们有2,323次怀孕，1,915名女性幸存者报告说有4,029次怀孕。接受子宫放射剂量超过5戈伊的妇女的后代更有可能小于胎龄（出生体重小于胎龄的10百分位数; 18.2%对7.8%;比值比= 4.0; 95% CI，1.6至9.8; P = 0.003）。后代中单纯畸形、细胞遗传学综合征或单基因缺陷的比例没有差异。这些研究表明，接受盆腔放疗和/或增加烷化剂剂量的妇女有急性卵巢功能衰竭、过早绝经和小于胎龄后代的风险。没有证据表明先天性畸形的风险增加。幸存者应该得到普遍的保证，尽管一些妇女在选择教育和职业时必须考虑到她们可能缩短的生育寿命。
These studies were undertaken to determine the effect, if any, of treatment for cancer diagnosed during childhood or adolescence on ovarian function and reproductive outcomes. We reviewed the frequency of acute ovarian failure, premature menopause, live birth, stillbirth, spontaneous and therapeutic abortion and birth defects in the participants in the Childhood Cancer Survivor Study (CCSS). Acute ovarian failure (AOF) occurred in 6.3% of eligible survivors. Exposure of the ovaries to high-dose radiation (especially over 10 Gy), alkylating agents and procarbazine, at older ages, were significant risk factors for AOF. Premature nonsurgical menopause (PM) occurred in 8% of participants versus 0.8% of siblings (rate ratio = 13.21; 95% CI, 3.26 to 53.51; P < .001). Risk factors for PM included attained age, exposure to increasing doses of radiation to the ovaries, increasing alkylating agent score, and a diagnosis of Hodgkin's lymphoma. One thousand two hundred twenty-seven male survivors reported they sired 2,323 pregnancies, and 1,915 female survivors reported 4,029 pregnancies. Offspring of women who received uterine radiation doses of more than 5 Gy were more likely to be small for gestational age (birthweight < 10 percentile for gestational age; 18.2% v 7.8%; odds ratio = 4.0; 95% CI, 1.6 to 9.8; P = .003). There were no differences in the proportion of offspring with simple malformations, cytogenetic syndromes, or single-gene defects. These studies demonstrated that women treated with pelvic irradiation and/or increasing alkylating agent doses were at risk for acute ovarian failure, premature menopause, and small-for-gestational-age offspring. There was no evidence for an increased risk of congenital malformations. Survivors should be generally reassured although some women have to consider their potentially shortened fertile life span in making educational and career choices.