癌症在開始治療前就會影響生育力


  【24drs.com】一篇新研究認為,就算在開始治療前,相較於沒有癌症的年齡相仿婦女,剛診斷有癌症的婦女,其空腔濾泡數(AFC)就比較少;AFC是卵泡儲量的指標。
  
  加州大學舊金山分校醫學院的Erin E. Ebbel在美國生殖醫學會(ASRM)第67屆年會發表研究發現。
  
  ASRM理事長Roger Lobo醫師在聲明中表示,對於哪種癌症影響生育力的機轉還需要更多研究,當我們的暸解越多,越可能發展出為這些有生育意願之抗癌婦女保留生育力的新療法。
  
  Ebbel等人在病歷回顧中比較了UCSF生殖健康保留計畫中心在2009-2011年間新診斷有癌症之200多名婦女的AFCs,對照組是年紀相仿的健康婦女。
  
  這些癌症婦女都沒有做過卵巢切除術、之前也無不孕,也還沒癌症治療或癌前病灶;癌症類型包括乳癌、婦科癌症、胃腸道癌症、血液惡性腫瘤、腦癌與黑色素瘤。
  
  研究者發現,平均而言,癌症婦女的AFC值低了35%。
  
  對於25-40歲的婦女,癌症婦女的AFC值顯著與健康對照組有所差異;對於41-45歲婦女,癌症病患和對照組之間的AFC差異則不顯著。
  
  表、各年齡層癌症患者和健康對照組的AFC中位數
年紀(歲)癌症 (AFC)對照組(預期AFC) P值
25-301420<.001
31-351115.004
36-40712<.001
41-4576.789

  研究者在壁報中指出,婦女的AFC值降低則發生不孕的風險變大,癌症治療會造成急性卵巢衰退或提早停經,因此必須商討進行卵母細胞或胚胎冷凍保存,以保留患者的生育力。
  
  UCSF生殖健康中心、生育力保留計畫與生殖實驗室主任Mitchell Rosen醫師表示,可能的原因是,AFC降低是因為對某種疾病的全身性反應,不過,他指出,需要更多研究來加以確認。
  
  Rosen醫師解釋,在特殊的案例中,我不認為這意味著這些病患在還沒有治療時就比較可能發生急性卵巢衰退或提早停經,可能是因為診斷後有更多的壓力而導致降低生育力,這點的實質意義在於卵巢儲量或濾泡的生長量是可以調控的。
  
  Rosen 醫師表示,需要更多研究來確認癌症病患的AFC降低是否反映出一種暫時性或永久性的過程,Rosen 醫師認為可能是暫時性的過程。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6634&x_classno=0&x_chkdelpoint=Y
  
  

Cancer May Affect Fertility Even Before Treatment

By Megan Brooks
Medscape Medical News

October 20, 2011 (Orlando, Florida) — Even before treatment, women with a recent diagnosis of cancer have a lower antral follicle count (AFC), an indicator of ovarian reserve, than age-matched cancer-free women, a new study suggests.

Erin E. Ebbel, from the University of California at San Francisco (UCSF) School of Medicine, reported the findings here at the the American Society for Reproductive Medicine (ASRM) 67th Annual Meeting.

In a statement, Roger Lobo, MD, president of ASRM, said, "More research is needed on the mechanisms by which cancer affects fertility. As we discover more, there is greater potential for the development of new treatments to preserve fertility for women fighting their disease, who want to plan for a family in the future," he added.

AFC 35% Lower

In a medical chart review, Ms. Ebbel and colleagues compared the AFCs of more than 200 women newly diagnosed with cancer at the UCSF Center of Reproductive Health Fertility Preservation Program between 2009 and 2011 with that of a control group of age-matched healthy women.

None of the women with cancer had a history of oophorectomy, prior infertility, previous cancer therapy, or precancerous lesions. Cancer types included breast cancer, gynecologic cancers, gastrointestinal cancers, hematologic malignancies, brain cancer, and melanoma.

On average, the AFC was 35% lower in women with cancer, the investigators found.

For women between the ages of 25 and 40 years, the AFC of women with cancer significantly differed from that of healthy controls. The difference in AFC between cancer patients and controls was not significant for women aged 41 to 45 years.

Table. Median AFC by Age in Patients With Cancer and Healthy Controls

Age (y) Cancer (AFC) Controls (Expected AFC) P Value
25-30 14 20 <.001
31-35 11 15 .004
36-40 7 12 <.001
41-45 7 6 .789

A Stress Response?

A woman with decreased AFC "may be at greater risk for experiencing infertility, acute ovarian failure or premature menopause from cancer therapy and therefore may be counseled to undergo oocyte or embryo cryopreservation in order to preserve her fertility," the investigators note in their poster.

"What is likely happening is that the decreased AFC may be the result of a systemic response due to having an illness," Mitchell Rosen, MD, UCSF director of the Fertility Preservation Program and Reproductive Laboratories, Center of Reproductive Health, told Medscape Medical News. He added, though, that more research is needed to confirm this.

"In this particular case, I don’t think that it means that these patients are more likely to experience acute ovarian failure or premature menopause in the absence of their treatment. It is likely more of a stress response possibly and consequently possibly resulting in lower fecundity. This essentially means that the ovarian reserve or the growing pool of follicles may be modifiable," Dr. Rosen explained.

Further research is needed to determine whether the decreased AFC in patients with cancer reflects a temporary or permanent process; "it is likely a temporary process," Dr. Rosen said.

The study was supported by grants from the National Institutes of Health. The authors have disclosed no relevant financial relationships.

American Society for Reproductive Medicine (ASRM) 67th Annual Meeting. Abstract P-315. Presented October 19, 2011.

    
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