乳腺癌预后因素对卵巢储备和生育能力的反应
Effect of breast cancer prognostic factors on ovarian reserve and response in fertility preservation
影响因子:3.50000
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
摘要
乳腺癌的预后因素是否会影响卵巢储量和在保存生育能力的背景下对卵巢刺激的反应？对352名乳腺癌的女性进行观察，双中心回顾性研究，她们在2015年11月2022年11月2022年11月之间使用促卵激素疗法的促进性激素疗法，这些乳腺癌刺激了卵巢刺激，并使用随机启动促进性激素释放激素疗法。测量和肛门卵泡数（AFC）。根据患者的特征和乳腺癌的预后因素分析了回收的卵母细胞的数量，成熟率和卵泡输出率（FORT）。米间年龄为34岁（31.1-37.1）。中位AFC和血清AMH水平分别为17（12-26）卵泡和2（1.2-3.4）Ng/ml。卵巢刺激后，回收10.5（6.0-16.0）卵母细胞，八（4-13）成熟。平均卵母细胞成熟率为79％（62-92）。肛门卵泡计数（> 12）显着影响恢复少于八个成熟卵母细胞的风险（P <0.0001，多元分析）。通过卵泡输出率（Fort指数）和回收的卵母细胞数量评估的FSH的卵泡反应性分别为31％（21-50）和10.5％（6.0-16.0）。堡垒指数和卵巢刺激结果不受乳腺癌的预后因素的影响。胸癌的预后因素不会影响卵巢储量标记或对保存生育能力的卵巢刺激的反应。因此，在考虑卵巢刺激卵母细胞玻璃化时，肿瘤等级，三阴性状态，HER2过表达和较高的KI67不应改变生育能力保存策略。
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.