■全球,越来越多的癌症女性在化疗期间接受促性腺激素释放激素激动剂(GnRHa)联合治疗,以保护卵巢.准则之间存在分歧,有些人建议GnRHa联合治疗乳腺癌患者,然而,GnRHa对未来生育率的影响是不确定的。
在这项基于人群的队列研究中,我们纳入了瑞典2005年7月至2017年3月期间所有15-45岁被诊断患有癌症的女性。在瑞典癌症登记册中确定。使用规定的药物登记册捕获GnRHa共同治疗的暴露。癌症分娩后,从医学出生登记册中提取,是主要结果。次要结果包括通过自然受孕(NC)实现的分娩,不孕症诊断和癌症死亡率。对于每个结果,使用延迟进入Cox模型估计调整后的风险比(AHR)和95%置信区间(CI),按年龄和癌症部位分层。
■在24,922名被诊断患有癌症的女性中,1.5%接受了GnRHa联合治疗。在80.2%的GnRHa暴露妇女中发现了乳腺癌诊断,GnRHa暴露与更高的分娩率无关(aHR1.23,95%CI0.80-1.89)。或NC分娩(AHR1.02,95%CI0.62-1.67),而不孕症的发生率明显较高(aHR2.42,95%CI1.44-4.08)。在患有淋巴瘤和其他癌症的女性中,GnRHa暴露与较高的分娩率无关,NC分娩或不孕症。GnRHa暴露与任何癌症类型的较高癌症死亡率无关。
■我们没有发现生育能力改善或维持的证据,估计癌症后的分娩率,在癌症治疗期间接受GnRHa的女性中。
■这项研究由瑞典癌症协会的研究资助(CAN2017/704;190249Pj,200170F),瑞典研究委员会(DNR2019-00446),北欧癌症联盟NCU(赠款2017),瑞典儿童癌症基金会(KP2016-0031)福斯金斯方德(Dnr:201313),斯德哥尔摩县议会(FoUI-953912)和卡罗林斯卡学院(Dnr2020-01963)。
UNASSIGNED: Worldwide, an increasing number of women with cancer are receiving Gonadotropin Releasing Hormone agonist (GnRHa) co-treatment during chemotherapy aiming at ovarian protection. There is divergence among guidelines, and some have recommended GnRHa co-treatment for women with breast cancer, however, the effect of GnRHa on future fertility is uncertain.
UNASSIGNED: In this population-based cohort
study we included all women diagnosed with cancer at ages 15-45 between July 2005 and March 2017 in Sweden, identified in the Swedish Cancer Register. Exposure to GnRHa co-treatment was captured using the Prescribed Drug Register. Post-cancer childbirth, extracted from the Medical Birth Register, was the main outcome. Secondary outcomes included childbirths achieved through natural conception (NC), infertility diagnosis and cancer mortality. For each outcome, adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were estimated using delayed-entry Cox models, stratified by age and cancer site.
UNASSIGNED: Among 24,922 women diagnosed with cancer, 1.5% had GnRHa co-treatment. Breast cancer diagnoses were found in 80.2% of GnRHa exposed women and the GnRHa exposure was not associated with higher rates of childbirth (aHR 1.23, 95% CI 0.80-1.89), or NC childbirth (aHR 1.02, 95% CI 0.62-1.67), whereas the rate of infertility was significantly higher (aHR 2.42, 95% CI 1.44-4.08). In women with lymphoma and other cancers, GnRHa exposure was not associated with higher rates of childbirth, NC childbirth or infertility. GnRHa exposure was not associated with higher cancer mortality for any cancer type.
UNASSIGNED: We did not find evidence of improved or maintained fertility, estimated as childbirth rates post-cancer, in women who received GnRHa during cancer treatment.
UNASSIGNED: This
study was financed by research grants from The Swedish Cancer Society (CAN 2017/704; 190249Pj, 200170F), The Swedish Research Council (Dnr 2019-00446), the Nordic Cancer Union NCU (Grant 2017), The Swedish Childhood Cancer Fund (KP2016-0031), Radiumhemmets Forskningsfonder (Dnr: 201313), Stockholm County Council (FoUI-953912) and Karolinska Institutet (Dnr 2020-01963).