The complexity and challenges of fertility preservation in women with cervix cancer-A prospective cohort study reporting on reproductive outcome and overall survival.

IF 3.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Acta Obstetricia et Gynecologica Scandinavica Pub Date : 2024-11-20 DOI:10.1111/aogs.15007
Anna Marklund, Yanyu Jiang, Hanna Röjlar, Fotios Sergonioutis, Hanna Nilsson, Frida E Lundberg, Kenny A Rodriguez-Wallberg
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Abstract

Introduction: Our objective was to assess the feasibility of fertility preservation (FP) in women referred for cervix cancer, the long-term reproductive outcome, and overall survival.

Material and methods: Prospective cohort study of patients referred for FP counseling between 1999 and 2021 to the FP program of Karolinska University Hospital, Stockholm, Sweden. Baseline data included age, parity, disease stage, treatment characteristics, and FP methods applied. Data on reproductive outcomes and overall survival (by October 19, 2023) were retrieved from clinical registries and a population-based register.

Trial registration number: ClinicalTrials.gov NTC04602962.

Results: In total, 91 women were referred, 67% with stage I cancers and 25%, 7%, and 1% with stages II, III, and IV, respectively. Cancers were diagnosed during pregnancy or postpartum in six cases. Cancer treatments included fertility-sparing surgery in 14%, hysterectomy in 30%, and radiochemotherapy in 79% of cases. The treatment modality did not rule out the possibility to undergo FP, and following counseling, 68 patients elected to undergo FP by cryopreservation of embryos or oocytes (N = 11), ovarian tissue (N = 54), or both (N = 3). After a mean follow-up of 8.1 years, 25 women (37%) returned to the center, five women achieved conception either spontaneously or through assisted reproduction, and 11 women became mothers through adoption or surrogacy. In the group of women receiving radical surgery or chemo/radiotherapy, no live births using cryopreserved specimens have yet been achieved. During follow-up, 7 women (10%) in the FP group and 5 women (24%) in the group without FP had died of their disease. Cancer recurrence was documented in 19 patients.

Conclusions: Our findings underscore the complexity and challenges associated with FP in the context of cervix cancer. Results of this study demonstrate that many women diagnosed with cervix cancer at reproductive age desire to achieve parenthood. While fertility-sparing surgery can allow pregnancy, those who undergo a hysterectomy are limited to adoption, surrogacy, or the emerging possibility of uterus transplantation.

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宫颈癌妇女生育力保存的复杂性和挑战--一项前瞻性队列研究,报告生育结果和总生存率。
导言我们的目的是评估因宫颈癌转诊的妇女进行生育力保存(FP)的可行性、长期生育结果和总生存率:对1999年至2021年间转诊至瑞典斯德哥尔摩卡罗林斯卡大学医院FP项目接受FP咨询的患者进行前瞻性队列研究。基线数据包括年龄、奇偶数、疾病分期、治疗特征以及所采用的 FP 方法。生殖结果和总生存期(截至2023年10月19日)的数据来自临床登记和人口登记:试验注册号:ClinicalTrials.gov NTC04602962:共有 91 名妇女被转诊,其中 67% 为 I 期癌症,25%、7% 和 1% 分别为 II、III 和 IV 期癌症。有 6 例癌症患者是在怀孕期间或产后确诊的。癌症治疗包括14%的保胎手术、30%的子宫切除术和79%的放射化疗。在接受咨询后,68名患者选择通过冷冻保存胚胎或卵母细胞(11例)、卵巢组织(54例)或两者(3例)的方式进行计划生育。经过平均 8.1 年的随访,25 名妇女(37%)重返该中心,5 名妇女自然受孕或通过辅助生殖受孕,11 名妇女通过领养或代孕成为母亲。在接受根治性手术或化疗/放疗的妇女群体中,尚未有使用冷冻保存标本的活产案例。在随访期间,FP 组中有 7 名妇女(10%)和未接受 FP 组中有 5 名妇女(24%)死于癌症。19名患者癌症复发:我们的研究结果凸显了 FP 在宫颈癌治疗中的复杂性和挑战性。这项研究结果表明,许多在育龄期被诊断出患有宫颈癌的妇女都希望能够生儿育女。虽然保胎手术可以让她们怀孕,但那些接受子宫切除术的妇女只能选择收养、代孕或新出现的子宫移植。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.00
自引率
4.70%
发文量
180
审稿时长
3-6 weeks
期刊介绍: Published monthly, Acta Obstetricia et Gynecologica Scandinavica is an international journal dedicated to providing the very latest information on the results of both clinical, basic and translational research work related to all aspects of women’s health from around the globe. The journal regularly publishes commentaries, reviews, and original articles on a wide variety of topics including: gynecology, pregnancy, birth, female urology, gynecologic oncology, fertility and reproductive biology.
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