Reduced ovarian function in long-term survivors of radiation- and chemotherapy-treated childhood cancer.
Reduced ovarian function in long-term survivors of radiation- and chemotherapy-treated childhood cancer.
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DOI：
10.1097/00006254-200405000-00021
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发表时间：
2003-11
期刊：
影响因子：
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通讯作者：
E. Larsen;Jørn Müller;K. Schmiegelow;C. Rechnitzer;A. Andersen
中科院分区：
文献类型：
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作者：
E. Larsen;Jørn Müller;K. Schmiegelow;C. Rechnitzer;A. Andersen
70%的癌症儿童存活。然而，放疗和化疗可能会损害卵巢功能。这项以人群为基础的研究的目的是全面了解卵巢损伤的程度。卵巢功能在100名儿童癌症幸存者和21名年龄相仿的对照组中进行了评估。记录月经周期模式，并进行严格定时的卵巢超声检查和激素评估。诊断时存活者的中位年龄为5.4岁（范围0.1-15.3岁），进入研究时为25.7岁（18.5-44.4岁）。17名卵巢早衰的幸存者有卵泡耗竭或检测不到卵巢，FSH和LH升高，以及不可测量的卵泡抑素B。13名幸存者使用口服避孕药。有自然月经周期的存活者（n = 70）每个卵巢的卵巢体积小于对照组（中位数，4.8 vs. 6.8 cm（3）; P < 0.001），每个卵巢的有腔卵泡数量也较低（中位数，7.5 vs. 11; P < 0.001）。此外，与对照组相比，他们具有较低的甜菜碱B水平（中位数，94对111 pg/ml; P = 0.03）和较高的雌二醇水平（中位数，0.12对0.08 pM; P = 0.04）。用多元线性回归分析预测每个卵巢的窦卵泡总数，卵巢照射后窦卵泡数减少（β =-0.40，P < 0.001），烷化剂化疗（β =-0.25，P = 0.01），诊断时年龄较大（β =-0.25，P = 0.01），停药时间较长（β =-0.19，P = 0.044）。每六名女性幸存者中就有一人可能会出现卵巢早衰。在有自然月经周期的幸存者中，结果表明卵巢储备减少。因此，停止生育的时间可能比预期的要早得多。应告知有自然周期的成年幸存者计划生育。
Seventy percent of children with cancer survive. Radiation and chemotherapy may, however, impair ovarian function. The aim of this population-based study was to achieve a comprehensive knowledge of the degree of ovarian damage. Ovarian function was evaluated in 100 childhood cancer survivors and 21 controls of similar age. Menstrual cycle pattern was recorded, and strictly timed ovarian sonography and hormonal assessment were performed. The median age of the survivors was 5.4 yr (range, 0.1-15.3) at the time of diagnosis and 25.7 yr (18.5-44.4) at study entry. Seventeen survivors with premature ovarian failure had follicle-depleted or nondetectable ovaries, elevated FSH and LH, and immeasurable inhibin B. Thirteen survivors used oral contraception. Survivors with spontaneous menstrual cycles (n = 70) had smaller ovarian volume per ovary than controls (median, 4.8 vs. 6.8 cm(3); P < 0.001) and a lower number of antral follicles per ovary (median, 7.5 vs. 11; P < 0.001). Further, they had lower inhibin B levels than controls (median, 94 vs. 111 pg/ml; P = 0.03) and higher estradiol levels (median, 0.12 vs. 0.08 pM; P = 0.04). Multiple linear regression analysis was performed to predict the total antral follicle number per ovary, and it showed a reduced number with ovarian irradiation (beta = -0.40, P < 0.001), alkylating chemotherapy (beta = -0.25, P = 0.01), older age at diagnosis (beta = -0.25, P = 0.01), and longer time period off treatment (beta = -0.19, P = 0.044). One in every six female survivors may develop premature ovarian failure. In survivors with spontaneous menstrual cycles, the results indicate a diminished ovarian reserve. Consequently, cessation of fertility may occur much earlier than anticipated. Adult survivors with spontaneous cycles should be informed hereof to plan childbearing.