生育力保存对乳腺癌治疗时机、复发和生存的影响。
The impact of fertility preservation on the timing of breast cancer treatment, recurrence, and survival.
机构信息
Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
出版信息
Cancer. 2021 Oct 15;127(20):3872-3880. doi: 10.1002/cncr.33601. Epub 2021 Jun 23.
BACKGROUND
Many young women with breast cancer undergo fertility preservation (FP) before cancer treatment. This study examined the impact of FP on breast cancer outcomes.
METHODS
The authors performed a retrospective cohort study of 272 women aged 20 to 45 years with newly diagnosed stage 0 to III breast cancer who underwent an FP consultation between 2005 and 2017. Among these women, 123 (45.2%) underwent FP (fertility preservation-positive [FP+]). The remaining 149 women did not undergo FP (fertility preservation-negative [FP-]).
RESULTS
The characteristics at enrollment were similar with the exception of ethnicity (FP+, 87.8% White; FP-, 67.8% White; P = .002) and BRCA status (FP+, 27.7% BRCA+; FP-, 15.5% BRCA+; P = .021). The median follow-up was approximately 4 years. Women who underwent FP had longer times to first treatment (FP+, 37 days; FP-, 31 days; adjusted hazard ratio [aHR], 0.74; confidence interval [CI], 0.56-0.99) and neoadjuvant chemotherapy (FP+, 36 days; FP-, 26 days; aHR, 0.41; CI, 0.24-0.68) and from surgery to adjuvant chemotherapy (FP+, 41 days; FP-, 33 days; aHR, 0.58; CI, 0.38-0.90). Adjusted 3- and 5-year invasive disease-free survival (IDFS) rates were comparable between the 2 groups (3-year IDFS: FP+, 85.4%; FP-, 79.4%; P = .411; 5-year IDFS: FP+, 73.7%; FP-, 67.1%; P = .288). Similarly, no difference in overall survival (OS) was observed between the 2 groups (3-year OS: FP+, 95.5%; FP-, 93.5%; P = .854; 5-year OS: FP+, 84.2%; FP-, 81.4%; P = .700).
CONCLUSIONS
FP after a breast cancer diagnosis delays the time to treatment by a small amount, but this delay does not lead to inferior IDFS or OS.
背景
许多患有乳腺癌的年轻女性在癌症治疗前会进行生育力保存（FP）。本研究探讨了 FP 对乳腺癌结局的影响。
方法
作者对 2005 年至 2017 年间接受 FP 咨询的 272 名年龄在 20 至 45 岁之间的新诊断为 0 至 III 期乳腺癌的女性进行了回顾性队列研究。其中 123 名（45.2%）女性进行了 FP（生育力保存阳性 [FP+]）。其余 149 名女性未进行 FP（生育力保存阴性 [FP-]）。
结果
除了种族（FP+，87.8%为白人；FP-，67.8%为白人；P=.002）和 BRCA 状态（FP+，27.7%BRCA+；FP-，15.5%BRCA+；P=.021）外，入组时的特征相似。中位随访时间约为 4 年。接受 FP 的女性首次治疗（FP+，37 天；FP-，31 天；调整后的危险比[aHR]，0.74；置信区间[CI]，0.56-0.99）和新辅助化疗（FP+，36 天；FP-，26 天；aHR，0.41；CI，0.24-0.68）以及从手术到辅助化疗（FP+，41 天；FP-，33 天；aHR，0.58；CI，0.38-0.90）的时间均较长。两组调整后的 3 年和 5 年浸润性无病生存率（IDFS）相当（3 年 IDFS：FP+，85.4%；FP-，79.4%；P=.411；5 年 IDFS：FP+，73.7%；FP-，67.1%；P=.288）。同样，两组的总生存（OS）无差异（3 年 OS：FP+，95.5%；FP-，93.5%；P=.854；5 年 OS：FP+，84.2%；FP-，81.4%；P=.700）。
结论
乳腺癌诊断后进行 FP 会使治疗时间略有延迟，但这种延迟不会导致 IDFS 或 OS 降低。
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