Assessment of ovarian reserve in adult childhood cancer survivors using anti-Mullerian hormone
Assessment of ovarian reserve in adult childhood cancer survivors using anti-Mullerian hormone
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DOI：
10.1093/humrep/den487
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发表时间：
2009-04-01
影响因子：
6.1
通讯作者：
van den Heuvel-Eibrink, M. M.
中科院分区：
文献类型：
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作者：
Fong, S. Lie;Laven, J. S. E.;van den Heuvel-Eibrink, M. M.
本研究的目的是使用抗苗勒管激素（AMH）（卵巢储备功能最敏感的标志物）评估一组成年女性儿童癌症幸存者（CCS）可能的治疗诱导性性腺损伤，将185名幸存者与42名对照组进行比较。中位随访时间为18.1年（范围4.1-43.2年），分析队列中的AMH浓度中位数与对照组无差异（中位数1.7 vs 2.1 μ g/l; P = 0.57）。然而，AMH水平低于正常值的第10百分位数在27%（49/182）的幸存者。此外，43%（79/182）的AMH水平低于1.4 μ g/l，这是先前确定的预测辅助生殖后继续妊娠的临界值。在根据疾病分类的亚组中，AMH水平没有差异。然而，接受三个或三个以上含甲基苄肼化疗周期治疗的幸存者的AMH水平显著低于对照组（中位数0.5 μ g/l; P = 0.004）。同样，接受腹部或全身放射治疗的存活者的AMH水平也明显低于对照组（中位数< 0.1 μ g/l; P < 0.001），AMH可用于鉴别CCS亚组中生育力降低或卵巢早衰的风险。在这些幸存者中，在开始治疗之前应考虑生育能力保留的选择，因为他们在辅助生殖治疗后可能面临怀孕机会不佳的风险。
The aim was to assess possible treatment-induced gonadal damage in a cohort of adult female childhood cancer survivors (CCS) using anti-Mullerian hormone (AMH), the most sensitive marker of ovarian reserve.A total cohort of 185 survivors was compared with 42 control subjects. The median follow-up time was 18.1 years (range 4.1-43.2 year).Median AMH concentrations in the analysed cohort were not different from controls (median 1.7 versus 2.1 mu g/l; P = 0.57). However, AMH levels were lower than the 10th percentile of normal values in 27% (49/182) of our survivors. In addition, 43% (79/182) had AMH levels lower than 1.4 mu g/l, a previously established cut-off value which predicts ongoing pregnancy after assisted reproduction. There were no differences in AMH levels in subgroups classified according to disease. However, survivors treated with three or more procarbazine containing chemotherapy cycles had significantly lower AMH levels than controls (median 0.5 mu g/l; P = 0.004). Also survivors treated with abdominal or total body irradiation had significantly lower AMH levels than controls (median < 0.1 mu g/l; P < 0.001).AMH can be used to identify subgroups of CCS at risk for decreased fertility or premature ovarian failure. In these survivors, options for fertility preservation should be considered prior to starting treatment since they may be at risk for poor chances of pregnancy after assisted reproductive treatment.