背景:世界范围内越来越多的中心正在保护处于生育能力丧失风险的年轻男孩的睾丸组织(TT),以保护他们的生育能力。这方面的数据很少,经验共享对于优化流程至关重要。
目的:我们10年的儿科生育力保存(FP)活动的报告的目的是(i)提高有关可行性的知识,可接受性,安全,和该程序的潜在有用性;(ii)分析冷冻保存的TT中化疗对精原细胞的影响。
方法:对于前瞻性记录的数据的回顾性研究,我们纳入了2009年10月至2019年12月期间向我们学术网络FP咨询的所有18岁以下男孩.从临床数据库中提取患者的特征和睾丸组织(CTT)的冷冻保存。单变量和多变量分析用于评估与睾丸组织中精原细胞缺失风险相关的因素。
结果:三百六十九名患者(7.2岁;0.5-17.0)因恶性(70%)或非恶性(30%)疾病而接受FP咨询,其中88%是CTT的候选人,在之前的化疗暴露后(78%)。记录的即时不良事件率为3.5%,痛苦的情节占主导地位。在大多数睾丸组织中检测到精原细胞:暴露于化疗的患者为91.1%,未暴露的患者为92.3%(p=0.962)。在多变量分析中,在年龄>10岁的男孩中,精原细胞缺失的风险几乎高出3倍([OR]2.74,95CI1.09~7.26,p=0.035),在CTT之前接受烷化剂治疗的男孩中,精原细胞缺失的风险高出4倍([OR]4.09,95CI1.32~17.94,p=0.028).
结论:这项大型儿科FP系列研究表明,该程序已被广泛接受,可行,在短期内是安全的,加强其在需要高度性腺毒性治疗的年轻患者的临床护理路径中的地位。我们的结果表明,化疗后CTT不会损害保留睾丸组织中精原细胞的机会,除非治疗包括烷化剂。仍需要更多关于CTT后随访的数据,以确保该程序的长期安全性和实用性。本文受版权保护。保留所有权利。
BACKGROUND: A growing number of centers worldwide are preserving testicular tissue (TT) of young boys at risk of fertility loss to preserve their fertility. Data in this regard are scarce and experience sharing is essential to the optimization of the process.
OBJECTIVE: This report of our 10-year activity of pediatric fertility preservation (FP) has the objective to (1) improve knowledge regarding the feasibility, acceptability, safety, and potential usefulness of the procedure; (2) analyze the impact of chemotherapy on spermatogonia in the cryopreserved TT.
METHODS: For this retrospective study of data prospectively recorded, we included all boys under 18 years of age referred to the FP consultation of our academic network between October 2009 and December 2019. Characteristics of patients and cryopreservation of testicular tissue (CTT) were extracted from the clinical database. Univariate and multivariate analyses were used to assess factors associated with the risk of absence of spermatogonia in the TT.
RESULTS: Three hundred and sixty-nine patients (7.2 years; 0.5-17.0) were referred to the FP consultation for malignant (70%) or non-malignant (30%) disease, of whom 88% were candidates for CTT, after a previous chemotherapy exposure (78%). The rate of recorded immediate adverse events was 3.5%, with painful episodes dominating. Spermatogonia were detected in the majority of TTs: 91.1% of those exposed to chemotherapy and 92.3% of those not exposed (p = 0.962). In multivariate analysis, the risk of absence of spermatogonia was almost three-fold higher in boys > 10 years of age ([OR] 2.74, 95% CI 1.09-7.26, p = 0.035) and four-fold higher in boys exposed to alkylating agents prior to CTT ([OR] 4.09, 95% CI 1.32-17.94, p = 0.028).
CONCLUSIONS: This large series of pediatric FP shows that this procedure is well accepted, feasible, and safe in the short term, strengthening its place in the clinical care pathway of young patients requiring a highly gonadotoxic treatment. Our results demonstrate that CTT post-chemotherapy does not impair the chance to preserve spermatogonia in the TT except when the treatment includes alkylating agents. More data on post-CTT follow-up are still required to ensure the long-term safety and usefulness of the procedure.