GnRHa对绝经前乳腺癌患者化疗期间月经复潮和自然妊娠影响的Meta分析

发布时间：2019-03-04 09:50

【摘要】：背景:绝经前乳腺癌患者越来越关注化疗期间导致的卵巢早衰及不孕不育。最新的卵巢功能保护策略就是化疗联合使用促性腺激素释放激素激动剂(Gn RHa),但临床疗效不一,缺乏更全面关于保护卵巢及生育功能分析的数据。目的:研究绝经前乳腺癌患者化疗联合GnRHa保护卵巢功能提高月经复潮及生育功能,为临床决策和实践提供参考。方法:检索EMBASE、Pubmed、中国知网、MEDLINE、万方网及科技网等电子数据库,收集并纳入截至2016年12月份的使用促性腺激素释放激素类似物预防或治疗绝经前乳腺癌患者化疗期间卵巢功能保护及生育功能恢复方面的随机对照试验研究,仅限于中文和英文文献。由两名研究人员独立操作完成文献筛选、数据提取、文献质量评价等过程,采用RevMan5.0、Stata 11.0统计软件进行Meta分析。结果:9项随机对照研究符合纳入标准,共858例绝经前乳腺癌患者,其中化疗联合GnRHa组为442例,单纯化疗组为416例。化疗联合GnRHa组自然月经复潮率高于单纯化疗组(OR=2.63,95%confidence interval(CI)=[1.50,4.63],P=0.0008)。但是,对于自然妊娠率来说,化疗联合GnRHa组和单纯化疗组结果没有统计学意义(OR=1.77,95%CI=[0.92,3.40];P=0.09)。在40岁年轻乳腺癌患者中,使用GnRHa对月经复潮有统计学意义(OR=2.26,95%CI=1.07,4.75;P=0.03)。而≥40岁乳腺癌患者则无统计学意义(OR=1.84,95%CI=0.78,4.35;P=0.16)。他莫昔芬联合GnRHa亚组和仅用他莫昔芬亚组对于月经复潮均无统计学意义,结果分别为(OR=1.45,95%CI=[0.90,2.33];P=0.12);(OR=1.44,95%CI=[0.91,2.30];P=0.12)。以蒽环类为基础方案化疗联合GnRHa对月经复潮有统计学意义(OR=2.49,95%CI=[1.06,5.89];P=0.04);以非蒽环类为基础方案化疗联合GnRHa结果为(OR=1.72,95%CI=[0.60,4.96];P=0.31)差异无统计学意义。发生不良反应亚组分析,化疗联合GnRHa组显著增加潮热发生,结果显示(OR=1.92,95%CI=[1.26,2.93];P=0.002)。然而,对于阴道干涩、情绪改变及性欲下降在实验组与对照组均无统计学意义,结果分别为(OR=1.46,95%CI=[0.69,3.10];P=0.32)、(OR=1.44,95%CI=[0.67,3.09];P=0.35)及(OR=1.55,95%CI=[0.68,3.53];P=0.29)。结论:GnRHa使绝经前乳腺癌患者化疗后月经复潮率提高,提示能有效保护患者卵巢功能,但对患者自然妊娠能否获益尚无法证实。仍需要进行更多大样本、多中心、高质量、同质性的随机对照试验来进一步证实GnRHa安全性及有效性。
[Abstract]:Background: premenopausal breast cancer patients are increasingly concerned about premature ovarian failure and infertility during chemotherapy. The most recent protective strategy for ovarian function is the combination of chemotherapy with gonadotropin-releasing hormone agonist (Gn RHa), but the clinical efficacy is different. There is a lack of more comprehensive data on the analysis of ovarian protection and fertility function. Aim: to study the effects of chemotherapy combined with GnRHa on ovarian function in patients with premenopausal breast cancer, and to provide reference for clinical decision-making and practice. Methods: to search the electronic databases such as EMBASE,Pubmed, China knowledge Network, MEDLINE, Wanfang Network and Science and Technology Network, etc. To collect and incorporate randomized controlled trial studies to prevent or treat ovarian function protection and fertility recovery during chemotherapy in premenopausal breast cancer patients using gonadotropin-releasing hormone analogues as of December 2016, Only in Chinese and English. The process of literature screening, data extraction and document quality evaluation was performed by two researchers independently. Meta analysis was carried out with RevMan5.0,Stata 11.0 statistical software. Results: a total of 858 patients with premenopausal breast cancer were enrolled in 9 randomized controlled studies, including 442 cases in chemotherapy combined with GnRHa group and 416 cases in chemotherapy alone group. The rate of spontaneous menstrual regurgitation in chemotherapy combined with GnRHa group was higher than that in chemotherapy group (OR=2.63,95%confidence interval (CI) = [1.50,4.63], P < 0.0008). However, for the natural pregnancy rate, there was no significant difference between the chemotherapy combined with GnRHa group and the chemotherapy alone group (OR=1.77,95%CI= [0.92, 3.40]; P < 0.05). In 40-year-old young breast cancer patients, the use of GnRHa was statistically significant for menstrual regurgitation (OR=2.26,95%CI=1.07,4.75;P=0.03). There was no statistical significance (OR=1.84,95%CI=0.78,4.35;P=0.16) in patients with breast cancer 鈮，

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