Cancer risk in children, adolescents, and young adults conceived by ART in 1983-2011.
Cancer risk in children, adolescents, and young adults conceived by ART in 1983-2011.
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DOI：
10.1093/hropen/hoad027
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发表时间：
2023
影响因子：
8.3
通讯作者：
中科院分区：
文献类型：
--
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与未通过ART受孕的低生育力夫妇和普通人群的儿童相比，ART（包括IVF，ICSI和冻融胚胎移植（FET））后出生的儿童，青少年和年轻人患癌症的风险是否增加？在中位随访18年后，ART受孕的儿童的总体癌症风险没有增加，但在ICSI后受孕的儿童中观察到轻微的风险增加。越来越多的证据表明，ART程序可能会扰乱植入前阶段的表观遗传过程，并影响长期健康。最近的研究表明，ICSI和FET后（非）显着增加癌症风险，但IVF后则没有。进行了一项具有前瞻性随访的全国性历史队列研究，包括1983年至2011年期间接受ART治疗的女性的所有活产后代，以及13个荷兰IVF诊所和两个生育中心之一未接受ART治疗的低生育力女性。通过个人记录数据库中母亲的记录确定儿童。通过母亲的医疗记录收集关于每个孩子的受孕方法的信息。总体而言，该队列包括89 249名生育力低下夫妇的活产婴儿，其中51 417名是使用ART受孕的，37 832名不是（即自然受孕，通过排卵诱导或IUI后）。癌症发病率是通过与荷兰癌症登记处1989-2019年期间的联系确定的。将使用抗逆转录病毒疗法怀孕的儿童的癌症风险与生育力低下夫妇所生但未通过抗逆转录病毒疗法怀孕的儿童的风险（风险比（HR））和一般人群的儿童（标准化发病率比（SIR））进行比较。在中位随访18年后，总共观察到358例癌症。与一般人群（SIR = 0.96，95% CI = 0.81-1.12）或未接受ART的低生育力夫妇的儿童（HR = 1.06，95% CI = 0.84-1.33）相比，接受ART的儿童总体癌症风险未增加。与未通过ART受孕的低生育力夫妇的儿童相比，使用IVF或FET与癌症风险增加无关，但ICSI与风险轻微增加相关（HR = 1.58，95%CI = 1.08-2.31）。与未接受ART的儿童相比，接受ART后的癌症风险在年龄较大时（≥18岁，HR = 1.26，95% CI = 0.88-1.81）并未增加。由于病例数量较少，必须谨慎解释使用ICSI受孕的儿童中观察到的风险增加。经过18年的中位随访，使用ART受孕的儿童总体癌症风险并没有增加。需要进行许多长期随访的大型研究，以调查接受不同类型ART的（年轻）成人的癌症风险。此外，建议进行国际汇总研究，以提供足够的力量来研究ART后特定癌症部位的风险。这项工作得到了荷兰癌症协会的支持（NKI 2006-3631），其资助了OMEGA-妇女队列，无癌症儿童（KIKA; 147），其资助了OMEGA-I-II后代队列。欧米茄-III后代队列得到了阿姆斯特丹生殖与发展博士后津贴和美国国立卫生研究院Eunice Kennedy Shriver国家儿童健康与人类发展研究所的支持，奖励编号为R 01 HD 088393。内容完全由作者负责，不一定代表美国国立卫生研究院的官方观点。作者声明没有竞争利益。N/A.
Do children, adolescents, and young adults born after ART, including IVF, ICSI and frozen–thawed embryo transfer (FET), have an increased risk of cancer compared with children born to subfertile couples not conceived by ART and children from the general population? After a median follow-up of 18 years, the overall cancer risk was not increased in children conceived by ART, but a slight risk increase was observed in children conceived after ICSI. There is growing evidence that ART procedures could perturb epigenetic processes during the pre-implantation period and influence long-term health. Recent studies showed (non-)significantly increased cancer risks after ICSI and FET, but not after IVF. A nationwide historical cohort study with prospective follow-up was carried out, including all live-born offspring from women treated with ART between 1983 and 2011 and subfertile women not treated with ART in one of the 13 Dutch IVF clinics and two fertility centers. Children were identified through the mothers’ records in the Personal Records Database. Information on the conception method of each child was collected through the mother’s medical record. In total, the cohort comprises 89 249 live-born children of subfertile couples, of whom 51 417 were conceived using ART and 37 832 were not (i.e. conceived naturally, through ovulation induction, or after IUI). Cancer incidence was ascertained through linkage with the Netherlands Cancer Registry for the period 1989–2019. Cancer risk in children conceived using ART was compared with risk in children born to subfertile couples but not conceived by ART (hazard ratio (HR)) and children from the general population (standardized incidence ratios (SIRs)). In total, 358 cancers were observed after a median follow-up of 18 years. Overall cancer risk was not increased in children conceived using ART, when compared with the general population (SIR = 0.96, 95% CI = 0.81–1.12) or with children from subfertile couples not conceived by ART (HR = 1.06, 95% CI = 0.84–1.33). Compared with children from subfertile couples not conceived by ART, the use of IVF or FET was not associated with increased cancer risk, but ICSI was associated with a slight risk increase (HR = 1.58, 95% CI = 1.08–2.31). Risk of cancer after ART did not increase at older ages (≥18 years, HR = 1.26, 95% CI = 0.88–1.81) compared to cancer risk in children not conceived by ART. The observed increased risk among children conceived using ICSI must be interpreted with caution owing to the small number of cases. After a median follow-up of 18 years, children conceived using ART do not have an increased overall cancer risk. Many large studies with prolonged follow-up are needed to investigate cancer risk in (young) adults conceived by different types of ART. In addition, international pooling of studies is recommended to provide sufficient power to study risk of specific cancer sites after ART. This work was supported by The Dutch Cancer Society (NKI 2006-3631) that funded the OMEGA-women’s cohort, Children Cancer Free (KIKA; 147) that funded the OMEGA-I–II offspring cohort. The OMEGA-III offspring cohort was supported by a Postdoc Stipend of Amsterdam Reproduction & Development, and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number R01HD088393. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no competing interests. N/A.
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影响因子：
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作者：
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