您的位置:山东大学 -> 科技期刊社 -> 《山东大学学报(医学版)》

山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (9): 42-46.doi: 10.6040/j.issn.1671-7554.0.2022.0880

• 生育力保护专题 • 上一篇    下一篇

乳腺癌患者生育力保护及保存

林芸,谢燕秋   

  1. 广东省人民医院生殖医学科 广东省医学科学院, 广东 广州510080
  • 发布日期:2022-09-02
  • 通讯作者: 林芸. E-mail:18688886223@163.com
  • 基金资助:
    国家重点研发计划(2021YFC2700404);广东省人民医院医学科研基金(8200060682,8190061121)

Fertility protection and preservation in breast cancer patients

LIN Yun, XIE Yanqiu   

  1. Department of Reproductive Medicine, Guangdong Provincial Peoples Hospital;
    Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China
  • Published:2022-09-02

摘要: 乳腺癌是女性最常见的恶性肿瘤。随着乳腺癌筛查的推广以及综合治疗的开展,乳腺癌患者的无瘤生存率和总生存率得到大大提高,年轻乳腺癌患者的生育需求受到越来越多的关注,生育力保存显得尤为重要。论文从乳腺癌治疗对卵巢功能的影响、生育力保存的方法以及乳腺癌患者进行辅助生殖相关研究进展三个方面进行阐述,为临床上乳腺癌患者进行生育力保存提供参考。

关键词: 乳腺癌, 生育力保存, 卵巢功能, 卵子和胚胎冻存, 卵巢组织冻存

Abstract: Breast cancer is the most common female malignant tumor all over the world. With the promotion of breast cancer screening and the development of comprehensive treatment, the disease-free survival rate and overall survival rate of breast cancer patients have been greatly improved. Physicians are concerned about the infertility problem of young breast cancer patient, and fertility preservation is the most effective treatment. This article illustrates the effects of breast cancer treatment on ovarian function, strategies of fertility preservation and research progress in assisted reproduction for breast cancer patients, which provides evidence for fertility preservation among breast cancer patients in clinical practice.

Key words: Breast cancer, Fertility preservation, Ovarian function, Oocyte and embryo cryopreservation, Ovarian tissue cryopreservation

中图分类号: 

  • R737.9
[1] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] 刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-13. LIU Zongchao, LI Zhexuan, ZHANG Yang, et al. Interpretation on the report of Global Cancer Statistics[J]. Journal of Multidisciplinary Cancer Management(Electronic Version), 2021, 7(2): 1-13.
[3] Li J, Zhang BN, Fan JH, et al. A nation-wide multicenter 10-year(1999-2008)retrospective clinical epidemiological study of female breast cancer in China[J]. BMC Cancer, 2011, 11: 364. doi: 10.1186/1471-2407-11-364.
[4] Oktay K, Harvey BE, Partridge AH, et al. Fertility preservation in patients with cancer: ASCO Clinical Practice Guideline update[J]. J Clin Oncol, 2018, 36(19): 1994-2001.
[5] Liem GS, Mo FK, Pang E, et al. Chemotherapy-related amenorrhea and menopause in young Chinese breast cancer patients: analysis on incidence, risk factors and serum hormone profiles[J]. PLoS One, 2015, 10(10): e0140842.
[6] Meirow D, Biederman H, Anderson RA, et al. Toxicity of chemotherapy and radiation on female reproduction[J]. Clin Obstet Gynecol, 2010, 53(4): 727-739.
[7] Overbeek A, van den Berg MH, van Leeuwen FE, et al. Chemotherapy-related late adverse effects on ovarian function in female survivors of childhood and young adult cancer: a systematic review[J]. Cancer Treat Rev, 2017, 53: 10-24. doi: 10.1016/j.ctrv.2016.11.006.
[8] Minisini AM, Menis J, Valent F, et al. Determinants of recovery from amenorrhea in premenopausal breast cancer patients receiving adjuvant chemotherapy in the taxane era[J]. Anticancer Drugs, 2009, 20(6): 503-507.
[9] Tiong V, Rozita AM, Taib NA, et al. Incidence of chemotherapy-induced ovarian failure in premenopausal women undergoing chemotherapy for breast cancer[J]. World J Surg, 2014, 38(9): 2288-2296.
[10] Shin JJ, Choi YM, Jun JK, et al. Amenorrhea and menopause in patients with breast cancer after chemotherapy[J]. J Breast Cancer, 2019, 22(4): 624-634.
[11] Furlanetto J, Marmé F, Seiler S, et al. Chemotherapy-induced ovarian failure in young women with early breast cancer: prospective analysis of four randomised neoadjuvant/adjuvant breast cancer trials[J]. Eur J Cancer, 2021, 152: 193-203. doi: 10.1016/j.ejca.2021.04.038.
[12] Lambertini M, Ceppi M, Cognetti F, et al. Dose-dense adjuvant chemotherapy in premenopausal breast cancer patients: a pooled analysis of the MIG1 and GIM2 phase III studies[J]. Eur J Cancer, 2017, 71: 34-42. doi: 10.1016/j.ejca.2016.10.030.
[13] Ganz PA, Cecchini RS, Fehrenbacher L, et al. NRG Oncology/NSABP B-47 menstrual history study: impact of adjuvant chemotherapy with and without trastuzumab[J]. NPJ Breast Cancer, 2021, 7(1): 55-61.
[14] Cosgrove CM, Salani R. Ovarian effects of radiation and cytotoxic chemotherapy damage[J]. Best Pract Res Clin Obstet Gynaecol, 2019, 55: 37-48. doi: 10.1016/j.bpobgyn.2018.07.008.
[15] Wallace WHB, Thomson AB, Saran F, et al. Predicting age of ovarian failure after radiation to a field that includes the ovaries[J]. Int J Radiat Oncol Biol Phys, 2005, 62(3): 738-744.
[16] Mazonakis M, Varveris H, Damilakis J, et al. Radiation dose to conceptus resulting from tangential breast irradiation[J]. Int J Radiat Oncol Biol Phys, 2003 55(2): 386-391.
[17] 中国年轻乳腺癌诊疗与生育管理专家共识专家委员会. 年轻乳腺癌诊疗与生育管理专家共识[J]. 中华肿瘤杂志, 2019, 41(7): 486-495.
[18] Abusief ME, Missmer SA, Ginsburg ES, et al. The effects of paclitaxel, dose density, and trastuzumab on treatment-related amenorrhea in premenopausal women with breast cancer[J]. Cancer, 2010, 116(4): 791-798.
[19] Ruddy KJ, Guo H, Barry W, et al. Chemotherapy-related amenorrhea after adjuvant paclitaxel-trastuzumab(APT trial)[J]. Breast Cancer Res Treat, 2015, 151(3): 589-596.
[20] Poorvu PD, Hu J, Zheng Y, et al. Treatment-related amenorrhea in a modern, prospective cohort study of young women with breast cancer[J]. NPJ Breast Cancer, 2021, 7(1): 99-105.
[21] Huser M, Smardova L, Janku P, et al. Fertility status of Hodgkin lymphoma patients treated with chemotherapy and adjuvant gonadotropin-releasing hormone analogues[J]. J Assist Reprod Genet, 2015, 32(8): 1187-1193.
[22] Horicks F, Van Den Steen G, Houben S, et al. Folliculogenesis is not fully inhibited during GnRH analogues treatment in mice challenging their efficiency to preserve the ovarian reserve during chemotherapy in this model[J]. PLoS One, 2015, 10(9): e0137164.
[23] Munhoz RR, Pereira AA, Sasse AD, et al. Gonadotropin-releasing hormone agonists for ovarian function preservation in premenopausal women undergoing chemotherapy for early-stage breast cancer: a systematic review and Meta-analysis[J]. JAMA Oncol, 2016, 2(1): 65-73.
[24] Lambertini M, Moore HCF, Leonard RCF, et al. Gonadotropin-releasing hormone agonists during chemotherapy for preservation of ovarian function and fertility in premenopausal patients with early breast cancer: a systematic review and Meta-analysis of individual patient-level data[J]. J Clin Oncol, 2018, 36(19):1981-1990.
[25] Moore HCF, Unger JM, Phillips KA, et al. Final analysis of the prevention of early menopause study(POEMS)/SWOG Intergroup S0230[J]. J Natl Cancer Inst, 2019, 111(2): 210-213.
[26] Zong X, Yu Y, Yang H, et al. Effects of gonadotropin-releasing hormone analogs on ovarian function against chemotherapy-induced gonadotoxic effects in premenopausal women with breast cancer in China: a randomized clinical trial[J]. JAMA Oncol, 2022, 8(2): 252-258.
[27] Preservation TEGGoFF. ESHRE FFP Guideline: female fertility preservation[J]. Hum Reprod Open, 2020: 1-17.
[28] 中华医学会生殖医学分会. 生育力保存中国专家共识[J]. 生殖医学杂志, 2021, 30(9): 1129-1134. Chinese Society of Reproductive Medicine. Chinese expert consensus on fertility preservation[J]. Journal of Reproductive Medicine, 2021, 30(9): 1129-1134.
[29] 中国妇幼保健协会生育力保存专业委员会. 女性生育力保存临床实践中国专家共识[J]. 中华生殖与避孕杂志, 2021, 41(5): 383-391.
[30] Dolmans MM, Luyckx V, Donnez J, et al. Risk of transferring malignant cells with transplanted frozen-thawed ovarian tissue[J]. Fertil Steril, 2013, 99(6): 1514-1522.
[31] Rodgers RJ, Reid GD, Koch J, et al. The safety and efficacy of controlled ovarian hyperstimulation for fertility preservation in women with early breast cancer: a systematic review[J]. Hum Reprod, 2017, 32(5): 1033-1045.
[32] Letourneau JM, Wald K, Sinha N, et al. Fertility preservation before breast cancer treatment appears unlikely to affect disease-free survival at a median follow-up of 43 months after fertility-preservation consultation[J]. Cancer, 2020, 126(3): 487-495.
[33] Oktay K, Hourvitz A, Sahin G, et al. Letrozole reduces estrogen and gonadotropin exposure in women with breast cancer undergoing ovarian stimulation before chemotherapy[J]. J Clin Endocrinol Metab, 2006, 91(10): 3885-3890.
[34] Turan V, Bedoschi G, Emirdar V, et al. Ovarian stimulation in patients with cancer: impact of letrozole and BRCA mutations on fertility preservation cycle outcomes[J]. Reprod Sci, 2018, 25(1): 26-32.
[35] Marklund A, Eloranta S, Wikander I, et al. Efficacy and safety of controlled ovarian stimulation using GnRH antagonist protocols for emergency fertility preservation in young women with breast cancer—a prospective nationwide Swedish multicenter study[J]. Hum Reprod, 2020, 35(4): 929-938.
[36] Oktay K, Buyuk E, Libertella N, et al. Fertility preservation in breast cancer patients: a prospective controlled comparison of ovarian stimulation with tamoxifen and letrozole for embryo cryopreservation[J]. J Clin Oncol, 2005, 23(19): 4347-4353.
[37] Oktay K, Turkcuoglu I, Rodriguez-Wallberg KA. GnRH agonist trigger for women with breast cancer undergoing fertility preservation by aromatase inhibitor/FSH stimulation[J]. Reprod Biomed Online, 2010, 20(6): 783-788.
[38] Goldrat O, Van Den Steen G, Gonzalez-Merino E, et al. Letrozole-associated controlled ovarian hyperstimulation in breast cancer patients versus conventional controlled ovarian hyperstimulation in infertile patients: assessment of oocyte quality related biomarkers[J]. Reprod Biol Endocrinol, 2019, 17(1): 3-11.
[39] Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers[J]. JAMA, 2017, 317(23): 2402-2416.
[40] Turan V, Demeestere I, Lambertini M, et al. Association of germline BRCA pathogenic variants with diminished ovarian reserve: a Meta-analysis of individual patient-level data[J]. J Clin Oncol, 2021, 39(18): 2016-2024.
[41] Rodriguez-Wallberg KA, Oktay K. Fertility preservation and pregnancy in women with and without BRCA mutation-positive breast cancer[J]. Oncologist, 2012, 17(11): 1409-1417.
[42] Derks-Smeets IA, de Die-Smulders CE, Mackens S, et al. Hereditary breast and ovarian cancer and reproduction: an observational study on the suitability of preimplantation genetic diagnosis for both asymptomatic carriers and breast cancer survivors[J]. Breast Cancer Res Treat, 2014, 145(3): 673-681.
[43] Hartnett KP, Mertens AC, Kramer MR, et al. Pregnancy after cancer: does timing of conception affect infant health?[J]. Cancer, 2018, 124(22): 4401-4407.
[44] 中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2021年版)[J]. 中国癌症杂志, 2021, 31(10): 954-1040.
[1] 古春青,郭睿思,周勤勤,刘恒辉,巴婉玉,孙士玲,王冰,郑玉玲,吴宿慧. 基于网络药理学和动物实验探讨酸枣仁-远志药对治疗乳腺癌相关性失眠的作用机制[J]. 山东大学学报 (医学版), 2026, 64(1): 99-108.
[2] 刘保国,宋翔,赵晓文,毛亚丽. 血清STAT5B、NKAIN1 mRNA检测在乳腺癌中的应用价值[J]. 山东大学学报 (医学版), 2025, 63(7): 68-74.
[3] 王雪梅,杨豪,宋洋,程世超,张婷婷,王艳春. 抗糖尿病药物与女性恶性肿瘤的因果关联:一项两样本孟德尔随机化分析[J]. 山东大学学报 (医学版), 2025, 63(6): 67-77.
[4] 余之刚,郑超. 乳腺癌多学科诊疗的现状、挑战与创新模式[J]. 山东大学学报 (医学版), 2025, 63(1): 1-9.
[5] 山东省医学会乳腺疾病多学科联合委员会. 乳腺癌多学科协作诊疗山东共识(2024年版)[J]. 山东大学学报 (医学版), 2025, 63(1): 10-16.
[6] 程跃启,王斐,于理想,郑超,余之刚. 曲妥珠单抗致HER2阳性乳腺癌患者心脏毒性的研究进展[J]. 山东大学学报 (医学版), 2025, 63(1): 17-24.
[7] 王敏, 李习平, 檀军, 邱梅, 侯泽宇, 田莹, 罗鸿莹, 范超文, 齐玲, 俞琦, 谢薇. 慢病毒载体介导Gag-Caspase-8诱导三阴性乳腺癌原代细胞凋亡及S期阻滞[J]. 山东大学学报 (医学版), 2025, 63(1): 25-34.
[8] 张洁,张芳芳,王靖楠,李泽宇,宋颖,李娜. circ_0000144在乳腺癌中的表达及其对乳腺癌细胞增殖、迁移和侵袭能力的影响[J]. 山东大学学报 (医学版), 2025, 63(1): 35-42.
[9] 宋雅雯,郭联涛,孔德光,孙圣荣. VTCN1导致HR+乳腺癌预后不良及内分泌治疗耐药[J]. 山东大学学报 (医学版), 2025, 63(1): 43-59.
[10] 刘晶晶,庞婧,赵晓丹,林昕,付敏,陈静静. 基于乳腺X线摄影及DCE-MRI机器学习模型预测乳腺癌新辅助治疗后病理完全缓解:双中心研究[J]. 山东大学学报 (医学版), 2025, 63(1): 60-72.
[11] 孙婧,杨瑞敏,王聪,张月,罗兵. 基于术前超声、炎症指标及超声影像组学联合模型预测乳腺癌腋窝淋巴结转移[J]. 山东大学学报 (医学版), 2025, 63(1): 73-80.
[12] 李永,崔书君,杨飞,张凡,殷晓霞. 基于增强MRI的亚区域影像组学模型可预测乳腺癌患者新辅助化疗后的病理完全反应[J]. 山东大学学报 (医学版), 2025, 63(1): 81-89.
[13] 袁宗怀,潘广晔,迟曰梅,安传国,张永刚. 孟德尔随机化分析低级别浆液性卵巢癌与乳腺癌的因果关系[J]. 山东大学学报 (医学版), 2025, 63(1): 99-107.
[14] 艾宪程,王斐,周文重,于理想,周飞,相玉娟,李亮,余之刚. 山东省38所三甲医院乳腺多学科诊疗现状[J]. 山东大学学报 (医学版), 2025, 63(1): 108-114.
[15] 刘向荣,张新胜,杨荩冉,杨雪艳,刘钊,刘英华. ω-6/ω-3多不饱和脂肪酸比值对不同肿瘤发病风险的系统综述和Meta分析[J]. 山东大学学报 (医学版), 2024, 62(8): 34-48.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
No Suggested Reading articles found!