乳腺癌预后因素对卵巢储备和促排反应的影响

Effect of breast cancer prognostic factors on ovarian reserve and response in fertility preservation

REPRODUCTIVE BIOMEDICINE ONLINE

影响因子:3.5

分区:医学2区 / 妇产科学2区生殖生物学2区

发表日期:2024 Nov

作者: Michaël Grynberg, Fayçal Zeghari, Maeliss Peigné, Alexandra Benoit, Sophia Rakrouki, Christophe Sifer, Anne Mayeur, Emine Saïs, Charlotte Sonigo

DOI: 10.1016/j.rbmo.2024.104109

摘要

乳腺癌预后因素是否影响卵巢储备和促排反应，用于生育保存？这是一项回顾性双中心观察研究，纳入2015年11月至2022年8月间接受促排卵和卵子冷冻的352名乳腺癌妇女。测量血清抗穆勒氏管激素（AMH）水平和窦卵泡数（AFC）。分析不同患者特征及乳腺癌预后因素对卵子回收数、成熟率和卵泡输出率（FORT）的影响。患者的中位年龄为34岁（31.1-37.1岁）。中位AFC为17（12-26），血清AMH为2（1.2-3.4）ng/ml。促排后，平均回收卵子为10.5（6.0-16.0），其中成熟卵子数为8（4-13），成熟率为79%（62-92%）。AFC（>12）显著降低成熟卵子少于8个的风险（P < 0.0001，多变量分析）。FSH刺激的卵泡反应（通过FORT指数和回收卵子数）分别为31%（21-50）和10.5%（6.0-16.0）。乳腺癌预后因素对FORT指数和促排反应无显著影响。结论：乳腺癌预后因素不影响卵巢储备指标或促排反应。因此，肿瘤分级、三阴性状态、HER2过表达和高Ki67不应影响考虑卵子冷冻的促排策略。

Abstract

Do breast cancer prognostic factors influence ovarian reserve and response to ovarian stimulation in the context of fertility preservation?Observational, bicentric retrospective study of 352 women with breast cancer who underwent ovarian stimulation using a random start gonadotrophin releasing hormone antagonist protocol and vitrified oocytes between November 2015 and August 2022. Serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) were measured. The number of oocytes recovered, maturation rate and follicular output rate (FORT) were analysed according to patients' characteristics and breast cancer prognostic factors.Median age was 34 years (31.1-37.1). Median AFC and serum AMH level were 17 (12-26) follicles and 2 (1.2-3.4) ng/ml, respectively. After ovarian stimulation, 10.5 (6.0-16.0) oocytes were recovered, with eight (4-13) being mature. Mean oocyte maturation rate was 79% (62-92). Antral follicle count (>12) significantly affected the risk of recovering fewer than eight mature oocytes (P < 0.0001, multivariate analysis). Follicular responsiveness to FSH, assessed by the follicular output rate (FORT index) and number of oocytes recovered, were 31% (21-50) and 10.5% (6.0-16.0), respectively. FORT index and ovarian stimulation outcomes were not influenced by breast cancer prognostic factors.Breast cancer prognostic factors do not influence ovarian reserve markers or response to ovarian stimulation in fertility preservation. Therefore, tumour grade, triple-negative status, HER2 overexpression and high Ki67 should not alter the fertility-preservation strategy when considering ovarian stimulation for oocyte vitrification.