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中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (02) : 150 -154. doi: 10.3877/cma.j.issn.1673-5250.2020.02.005

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乳腺癌患者生育力保存策略研究现状
吴怡媚1, 金丽1, 黄荷凤1,()   
  1. 1. 上海交通大学医学院附属国际和平妇幼保健院 200030
  • 收稿日期:2020-01-05 修回日期:2020-03-20 出版日期:2020-04-01
  • 通信作者: 黄荷凤

Research status of fertility preservation strategies in breast cancer patients

Yimei Wu1, Li Jin1, Hefeng Huang1,()   

  1. 1. International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Received:2020-01-05 Revised:2020-03-20 Published:2020-04-01
  • Corresponding author: Hefeng Huang
  • About author:
    Corresponding author: Huang Hefeng, Email:
  • Supported by:
    National Natural Science Foundation of China(81871140)
引用本文:

吴怡媚, 金丽, 黄荷凤. 乳腺癌患者生育力保存策略研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2020, 16(02): 150-154.

Yimei Wu, Li Jin, Hefeng Huang. Research status of fertility preservation strategies in breast cancer patients[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(02): 150-154.

乳腺癌是中国女性最高发的恶性肿瘤。随着乳腺癌诊断和治疗手段不断发展,患者总体生存率和无病生存率得到很大提高,育龄期乳腺癌患者的生育需求,也越来越受到关注。乳腺癌化疗、放疗、内分泌治疗过程中,具有不同程度生殖毒性,均可能损害乳腺癌患者的生育力。目前临床常用保存乳腺癌患者生育力策略,包括胚胎和卵母细胞冻存等已较为成熟和完善的生育力保存方式,新兴的卵巢组织冻存、卵子体外成熟(IVM)技术,以及仍然存在争议的化疗期间联用促性腺激素释放激素激动剂(GnRHa)保护卵巢的方案。乳腺癌患者完成治疗后,可以选择合适时机尝试妊娠,并且妊娠并不增加乳腺癌患者复发率和死亡率。笔者拟就乳腺癌治疗对患者生育力的影响、生育力保存策略、妊娠时机和安全性的最新研究进展进行阐述,旨在为临床保存乳腺癌患者生育力提供参考。

Breast cancer is the most common female malignant tumor in China. Thanks to the continuous development of breast cancer diagnosis and treatments strategies, the overall survival rate and disease-free survival rate have been greatly improved. The fertility demand of breast cancer patients of childbearing age has also received increasing attention. However, the anticancer treatments of breast cancer, such as chemotherapy, radiotherapy, and endocrine therapy, may impair gonadal function and lead to infertility of breast cancer patients. This article outlines current treatments strategies for fertility preservation of breast cancer patients, including the well-established methods such as embryo cryopreservation and oocyte cryopreservation, and the potential alternatives such as ovarian tissue cryopreservation and in vitro maturation (IVM) technique. The application of gonadotropin-releasing hormone agonists (GnRHa) to protect the ovary during chemotherapy is still under controversial. Breast cancer patients can choose the right time to try pregnancy after treatment, and pregnancy does not increase the recurrence rate and mortality of breast cancer patients. This article intends to elaborate on the latest research progresses on the impact of breast cancer treatment on fertility, fertility preservation strategies, timing and safety of pregnancy, and aims to provide references for fertility preservation of breast cancer patients.

[1]
Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015 [J]. CA Cancer J Clin, 2016, 66(2): 115-132. DOI: 10.3322/caac.21338.
[2]
Hassan Zafar MS, Khan AA, Aggarwal S, et al. Efficacy and tolerability of bortezomib and dexamethasone in newly diagnosed multiple myeloma [J]. South Asian J Cancer, 2018, 7(1): 58-60. DOI: 10.4103/sajc.sajc_59_17.
[3]
Puttabyatappa M, Padmanabhan V. Developmental programming of ovarian functions and dysfunctions [J]. Vitam Horm, 2018, 107: 377-422. DOI: 10.1016/bs.vh.2018.01.017.
[4]
Marci R, Mallozzi M, Di Benedetto L, et al. Radiations and female fertility [J]. Reprod Biol Endocrinol, 2018, 16(1): 112. DOI: 10.1186/s12958-018-0432-0.
[5]
Griffiths MJ, Winship AL, Hutt KJ. Do cancer therapies damage the uterus and compromise fertility? [J]. Hum Reprod Update, 2020, 26(2): 161-173. DOI: 10.1093/humupd/dmz041.
[6]
Bajpai J, Majumdar A, Satwik R, et al. Practical consensus recommendations on fertility preservation in patients with breast cancer [J]. South Asian J Cancer, 2018, 7(2): 110-114. DOI: 10.4103/sajc.sajc_113_18.
[7]
Munster PN. Effect of temporary ovarian suppression on chemotherapy-induced amenorrhea, pregnancy, and outcome [J]. JAMA Oncol, 2016, 2(8): 1089-1090. DOI: 10.1001/jamaoncol.2016.0614.
[8]
Roness H, Kashi O, Meirow D. Prevention of chemotherapy-induced ovarian damage [J]. Fertil Steril, 2016, 105(1): 20-29. DOI: 10.1016/j.fertnstert.2015.11.043.
[9]
Spears N, Lopes F, Stefansdottir A, et al. Ovarian damage from chemotherapy and current approaches to its protection [J]. Hum Reprod Update, 2019, 25(6): 673-693. DOI: 10.1093/humupd/dmz027.
[10]
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.
[11]
Lambertini M, Del Mastro L, Pescio MC, et al. Cancer and fertility preservation: international recommendations from an expert meeting [J]. BMC Med, 2016, 14(1): 1. DOI: 10.1186/s12916-015-0545-7.
[12]
Jyoti B, Bharat C, Ankita N, et al. Pregnancy on tamoxifen: case-report and review of literature [J]. South Asian J Cancer, 2016, 5(4): 209-210. DOI: 10.4103/2278-330X.195347.
[13]
Torino F, Barnabei A, De Vecchis L, et al. Chemotherapy-induced ovarian toxicity in patients affected by endocrine-responsive early breast cancer [J]. Crit Rev Oncol Hematol, 2014, 89(1): 27-42. DOI: 10.1016/j.critrevonc.2013.07.007.
[14]
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. DOI: 10.1200/JCO.2018.78.1914.
[15]
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. DOI: 10.1093/humrep/dex027.
[16]
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. DOI: 10.1002/cncr.32546.
[17]
Sonigo C, Sermondade N, Calvo J, et al. Impact of letrozole supplementation during ovarian stimulation for fertility preservation in breast cancer patients [J]. Eur J Obstet Gynecol Reprod Biol X, 2019, 4: 100049. DOI: 10.1016/j.eurox.2019.100049.
[18]
Quinn MM, Cakmak H, Letourneau JM, et al. Response to ovarian stimulation is not impacted by a breast cancer diagnosis [J]. Hum Reprod, 2017, 32(3): 568-574. DOI: 10.1093/humrep/dew355.
[19]
Taylan E, Oktay KH. Current state and controversies in fertility preservation in women with breast cancer [J]. World J Clin Oncol, 2017, 8(3): 241-248. DOI: 10.5306/wjco.v8.i3.241.
[20]
Doyle JO, Richter KS, Lim J, et al. Successful elective and medically indicated oocyte vitrification and warming for autologous in vitro fertilization, with predicted birth probabilities for fertility preservation according to number of cryopreserved cocytes and age at retrieval [J]. Fertil Steril, 2016, 105(2): 459-466.e2. DOI: 10.1016/j.fertnstert.2015.10.026.
[21]
Grynberg M, Poulain M, Le Parco S, et al. Similar in vitro maturation rates of oocytes retrieved during the follicular or luteal phase offer flexible options for urgent fertility preservation in breast cancer patients [J]. Hum Reprod, 2016, 31(3): 623-629. DOI: 10.1093/humrep/dev325.
[22]
Shirasawa H, Terada Y. In vitro maturation of human immature oocytes for fertility preservation and research material [J]. Reprod Med Biol, 2017, 16(3): 258-267. DOI: 10.1002/rmb2.12042.
[23]
Applications P, Ivm OF. In vitro maturation: a committee opinion [J]. Fertil Steril, 2013, 99(3): 663-666. DOI: 10.1016/j.fertnstert.2012.12.031.
[24]
Batchvarov IS, Taylor RW, Bustamante-Marin X, et al. A grafted ovarian fragment rescues host fertility after chemotherapy [J]. Mol Hum Reprod, 2016, 22(12): 842-851. DOI: 10.1093/molehr/gaw064.
[25]
Ruan X, Du J, Korell M, et al. Case report of the first successful cryopreserved ovarian tissue retransplantation in China [J]. Climacteric, 2018, 21(6): 613-616. DOI: 10.1080/13697137.2018.1514005.
[26]
Bastings L, Beerendonk CCM, Westphal JR, et al. Autotransplantation of cryopreserved ovarian tissue in cancer survivors and the risk of reintroducing malignancy: a systematic review [J]. Hum Reprod Update, 2013, 19(5): 483-506. DOI: 10.1093/humupd/dmt020.
[27]
Munhoz RR, Pereira AAL, 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. DOI: 10.1001/jamaoncol.2015.3251.
[28]
Zheng F, Zhu B, Feng Q, et al. Protective effect of gonadotropinreleasing hormone agonist against chemotherapyinduced ovarian dysfunction: a Meta-analysis [J]. Oncol Lett, 2019, 17(6): 5319-5326. DOI: 10.3892/ol.2019.10252.
[29]
Martinez F, International Society for Fertility Preservation-ESHRE-ASRM Expert Working Group. Update on fertility preservation from the Barcelona International Society for Fertility Preservation-ESHRE-ASRM 2015 expert meeting: indications, results and future perspectives [J]. Hum Reprod, 2017, 108(3): 407-415.e11. DOI: 10.1016/j.fertnstert.2017.05.024.
[30]
Coates AS, Winer EP, Goldhirsch A, et al. Tailoring therapies-improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015 [J]. Ann Oncol, 2015, 26(8): 1533-1546. DOI: 10.1093/annonc/mdv221.
[31]
Carneiro MM, Cota AM, Amaral MC, et al. Motherhood after breast cancer: can we balance fertility preservation and cancer treatment? A narrative review of the literature [J]. JBRA, 2018, 22(3): 244-252. DOI: 10.5935/1518-0557.20180032.
[32]
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(2019年版)[J]. 中国癌症杂志,2019, 29(8): 609-680. DOI: 10.19401/j.cnki.1007-3639.2019.08.009.
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