在接受化疗的癌症妇女中进行生育保护的干预措施
Maria Aj Weterings1, Elizabeth Glanville2, Rik van Eekelen3
1Maastrict University Medical Center, Maastricht, Netherlands.
The Cochrane database of systematic reviews
|June 19, 2025
概括
患有癌症的女性的生育能力保护包括使用GnRH激动剂进行受控的卵巢过度刺激或卵巢抑制. 卵巢抑制可能会减少卵巢衰竭,但其他结局的证据尚不确定.
科学领域:
- 生殖医学 生殖医学
- 在瘤学瘤学.
- 基于证据的医学基于证据的医学.
背景情况:
- 化疗可以导致不可逆转的卵巢损伤,导致过早的卵巢衰竭.
- 对于接受癌症治疗的女性来说,保持生育能力至关重要.
- 两种主要策略包括控制卵巢过度刺激 (COH) 与卵细胞/胚胎冷和卵巢抑制使用淋巴激素释放激素激动剂 (GnRH激动剂).
研究的目的:
- 评估COH与保护剂的有效性和安全性,与GnRH激动剂对抗,以保护癌症前绝经妇女的生育能力.
- 在接受化疗的妇女中比较不同的生育保存方法.
主要方法:
- 通过全面的数据库搜索 (CGF,CENTRAL,MEDLINE,Embase,PsycINFO) 确定的随机对照试验 (RCT) 的系统审查,截至2023年11月.
- 包括将COH与抗安慰剂/常规护理的保护剂进行比较的RCT,以及抗安慰剂/常规护理的GnRH激动剂.
- 主要结局:卵巢衰竭,活产,整体存活率. 二次结果:不良事件.
主要成果:
- 对于使用保护剂 (莱特 / 塔莫西芬) 的COH的证据非常不确定关于卵细胞产量,并且缺乏有关活产或生存的数据.
- 基因组激素激发剂可以显著减少化疗诱导的卵巢缺陷 (低确定性证据).
- 证据表明GnRH激动剂对活产和生存的影响非常低至低确定性;与怀孕无关的不良事件可能会增加.
结论:
- 对于乳腺癌患者来说,使用保护剂对COH的证据是不确定的,没有关于长期结果的数据.
- 基因激素激动剂显示出降低卵巢缺陷的潜力,但证据质量较低.
- 在COH和GnRH激动剂之间没有直接的比较数据存在,这排除了关于最佳策略的最终结论.
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