早期卵巢癌患者保留生育功能治疗的临床研究进展
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摘要
卵巢恶性肿瘤的发病率不断升高且呈现年轻化趋势,其中卵巢癌约占90%,随着二胎时代的到来,生育年龄的推迟,患者有更强烈的生育要求,因此,早期卵巢癌的保留生育功能治疗成为目前研究的热点,治疗手段仍在不断探索,其中对于保留生育功能手术(fertility-sparing surgery,FSS)的适应证、化疗药物对卵巢功能的损伤及如何有效保护卵巢生殖功能等尚有很多争议,本文将就相关研究的进展进行综述。
The incidence of ovarian cancer is increasing. Patients with ovarian cancer tend to be younger and younger.Epithelial ovarian cancer( EOC) accounted for 90% of ovarian cancers. As the second child policy and late childbearing are promoted,patients with EOC are likely to have a growing desire for childbearing and child-raring. Therefore,the research effort has focused on fertility preservation in the treatment of early EOC. Its treatment methods have been continuously improved. There is still considerable controversy in academic circles concerning indications of fertility-sparing surgery,damage of ovarian function caused by chemotherapeutic drugs as well as how to effectively protect reproductive system functions of the ovary. In this article,related research is summarized.
The incidence of ovarian cancer is increasing. Patients with ovarian cancer tend to be younger and younger.Epithelial ovarian cancer( EOC) accounted for 90% of ovarian cancers. As the second child policy and late childbearing are promoted,patients with EOC are likely to have a growing desire for childbearing and child-raring. Therefore,the research effort has focused on fertility preservation in the treatment of early EOC. Its treatment methods have been continuously improved. There is still considerable controversy in academic circles concerning indications of fertility-sparing surgery,damage of ovarian function caused by chemotherapeutic drugs as well as how to effectively protect reproductive system functions of the ovary. In this article,related research is summarized.
引文
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[3] Siegel RL,Miller KD,Jemal A. Cancer statistics,2018[J]. CA Cancer J Clin. 2018,68(1)∶7-30.
[4] Utrilla-Layna J,Zapardiel I. Are we ready for conservative treatment in ovarian cancer?[J]. J Gynecol Oncol,2015,26(1)∶75-76.
[5] Prat J. New insights into ovarian cancer pathology[J]. Ann Oncol,2012,23(suppl10)∶x111-x117.
[6] Desai A,Xu J,Aysola K,et al. Epithelial ovarian cancer∶An overview[J]. World J Transl Med,2014,3(1)∶1-8
[7]魏旭,张国楠.早期上皮性卵巢癌术后辅助化疗及疗程对其预后的影响[J].肿瘤预防与治疗,2017,30(2)∶143-147.
[8] Panici PB,Marchetti C,Salerno L,et al. Dualistic classification of epithelial ovarian cancer∶surgical and survival outcomes in a large retrospective series[J]. Ann Surg Oncol,2014,21(9)∶3036-3041.
[9] Devouassoux-Shisheboran M,Genestie C,Ray-Coquard I. Dualistic classification of epithelial ovarian cancer∶Is it clinically relevant?[J]. Bull Cancer,2016,103(3)∶252-258.
[10]王玉.年轻Ⅰ期上皮性卵巢癌患者保留生育功能治疗的预后及妊娠结局Meta分析[D].南昌∶南昌大学,2018.
[11] Frielink LMJ,Pijlman BM,Ezendam NPM,et al. Clinical practice of adjuvant chemotherapy in patients with early-stage epithelial ovarian cancer[J]. Chemotherapy,2016,61(6)∶287-294.
[12] Romanidis K,Nagorni EA,Halkia E,et al. The role of cytoreductive surgery in advanced ovarian cancer∶the general surgeon's perspective[J]. J BUON,2014,19(3)∶598-604.
[13] Dong X,Men X,Zhang W,et al. Advances in tumor markers of ovarian cancer for early diagnosis[J]. Indian J Cancer,2014,51(Suppl 3)∶e72-e76.
[14] Yi H,Ye J,Yang XM,et al. High-grade ovarian cancer secreting effective exosomes in tumor angiogenesis[J]. Int J Clin Exp Pathol,2015,8(5)∶5062-5070.
[15] Shimada T,Saito T,Shimokawa M,et al. Improvement in the prognosis of ovarian cancer in the era before addition of molecular targeting therapy[J]. Jpn J Clin Oncol,2017,47(6)∶494-498.
[16] Men CD,Liu QN,Ren Q. A prognostic 11 genes expression model for ovarian cancer[J]. J Cell Biochem,2018,119(2)∶1971-1978.
[17] Satoh T,Yoshikawa H. Fertility-sparing surgery for early stage epithelial ovarian cancer[J]. Jpn J Clin Oncol,2016,46(8)∶703-710.
[18] Bentivegna E,Maulard A,Miailhe G,et al. Gynaecologic cancer surgery and preservation of fertility[J]. J Visc Surg,2018,155(suppl 1)∶s23-s29.
[19] Bergamini A,Petrone M,Rabaiotti E,et al. Fertility sparing surgery in epithelial ovarian cancer in Italy∶perceptions,practice,and main issues[J]. Gynecol Endocrinol,2017,34(4)∶305-308.
[20]中华医学会妇科肿瘤学分会.妇科恶性肿瘤保留生育功能临床诊治指南[J].中华妇产科杂志,2014,49(4)∶243-248.
[21] Ditto A,Martinelli F,Lorusso D,et al. Fertility sparing surgery in early stage epithelial ovarian cancer[J]. J Gynecol Oncol,2014,25(4)∶320-327.
[22]江彩霞,程忠平,万悦竹,等.腹腔镜与开腹手术在早期卵巢癌全面分期手术中的疗效和并发症比较[J].国际妇产科学杂志,2016,43(5)∶528-538.
[23] Zapardiel I,Diestro MD,Aletti G. Conservative treatment of early stage ovarian cancer∶oncological and fertility outcomes[J]. Eur J Surg Oncol,2014,40(4)∶387-393.
[24] Bentivegna E,Morice P,Uzan C,et al. Fertility-sparing surgery in epithelial ovarian cancer.[J]. Ann Oncol,2016,12(3)∶389-398.
[25] Park JY,Heo EJ,Lee JW,et al. Outcomes of laparoscopic fertility-sparing surgery in clinically early-stage epithelial ovarian cancer[J]. J Gynecol Oncol,2016,27(2)∶e20.
[26] Fruscio R,Ceppi L,Corso S,et al. Long-term results of fertilitysparing treatment compared with standard radical surgery for earlystage epithelial ovarian cancer[J]. Br J Cancer,2016,115(6)∶641-648.
[27] Hedbck NE,Karlsen MA,Hgdall CK,et al. Survival of selected patients with ovarian cancer treated with fertility-sparing surgery[J]. Reprod Biomed Online,2018,37(1)∶71-76.
[28] Berveiller P,Carbonne B,Mir O. Cancer and pregnancy∶an overview for obstetricians and gynecologists[J]. Am J Obstet Gynecol,2014,211(1)∶82.
[29] Germana T,Mario C,Monica R,et al. Prognostic factors in earlystage ovarian cancer[J]. Ecancermedicalscience,2013,7∶325-341.
[30] Fotopoulou C,Braicu I,Sehouli J. Fertility-sparing surgery in early epithelial ovarian cancer∶a viable option?[J]. Obstet Gynecol Int,2012,2012∶1-8.
[31] Letourneau J,Chan J,Salem W,et al. Fertility sparing surgery for localized ovarian cancers maintains an ability to conceive,but is associated with diminished reproductive potential[J]. J Surg Oncol,2015,112(1)∶26-30.
[32]张颖,杨佳欣,曹冬焱,等.早期上皮性卵巢癌保留生育功能手术患者预后与妊娠状况的影响因素[J].山东大学学报(医学版),2018,56(5)∶13-17.
[33] Schüring AN,Fehm T,Behringer K,et al. Practical recommendations for fertility preservation in women by the Ferti PROTEKT network. Part I∶Indications for fertility preservation[J]. Arch Gynecol Obstet,2018,297(1)∶241-255.
[34] Martínez F,Devesa M,Coroleu B,et al. Cancer and fertility preservation∶Barcelona consensus meeting[J]. Gynecol Endocrinol,2013,29(4)∶285-291.
[35] Feichtinger M,Rodriguezwallberg KA. Fertility preservation in women with cervical,endometrial or ovarian cancers[J]. Gynecol Oncol Res Pract,2016,3(1)∶8.
[36]祝洪澜,崔恒.卵巢恶性肿瘤保留生育功能后化疗的策略及卵巢保护[J].实用妇产科杂志,2016,32(11)∶807-809.
[37]王新宇,谢幸.上皮性卵巢癌保留生育功能治疗[J].中国实用妇科与产科杂志,2012,28(3)∶172-174.
[38] Cordeiro CN,Gemignani ML. Gynecologic malignancies in pregnancy∶balancing fetal risks with oncologic safety[J]. Obstet Gynecol Surv,2017,72(3)∶184-193.
[39] Blumenfeld Z,Zur H,Dann EJ. Gonadotropin-releasing hormone agonist cotreatment during chemotherapy may increase pregnancy rate in survivors[J]. Oncologist,2015,20(11)∶1283-1289.
[40] Lambertini M,Ceppi M,Poggio F,et al. Ovarian suppression using luteinizing hormone-releasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients∶a meta-analysis of randomized studies[J]. Ann Oncol,2015,51(12)∶2408-2419.
[41] Demeestere I,Turan V,Oktay K. Pregnancy rate and preservation of cyclic ovarian function with gonadotropin-releasing hormone agonist cotreatment during chemotherapy-reply[J]. JAMA Oncol,2016,2(4)∶546-547.
[42] Blumenfeld Z,Evron A. Preserving fertility when choosing chemotherapy regimens-the role of gonadotropin-releasing hormone agonists[J]. Expert Opin Pharmacother,2015,16(7)∶1009-1020.
[43] Yang B,Yu Y,Chen J,et al. Possibility of women treated with fertility-sparing surgery for non-epithelial ovarian tumors to safely and successfully become pregnant-a Chinese retrospective cohort study among 148 cases[DB/OL]. https://doi. org/10. 1007/s11684-017-0554-3,2017-12-07.
[44] Srikanthan A,Amir E,Bedard P,et al. Fertility preservation in post-pubescent female cancer patients∶A practical guide line for clinicians[J]. Mol Clin Oncol. 2018; 8(1)∶153-158.
[45] Maclaughlin DT,Donahoe PK. Müllerian inhibiting substance/antiMüllerian hormone∶a potential therapeutic agent for human ovarian and other cancers[J]. Future Oncol,2010,6(3)∶391-405.
[46] Wong RR,Jr WM,Chung TK,et al. An update on Mullerian-inhibiting substance∶its potential application against ovarian cancer[J]. Endocr Relat Cancer,2014,21(3)∶R227-R233.
[47] Di CT,Casorelli A,Morrocchi E,et al. Fertility management for malignant ovarian germ cell tumors patients[J]. Crit Rev Oncol Hematol,2017,120∶34-42.
[48] Papa A,Caruso D,Strudel M,et al. Update on poly-ADP-ribose polymerase inhibition for ovarian cancer treatment[J]. J Transl Med,2016,14(1)∶267-285.
[49] Mccann KE. Novel poly-ADP-ribose polymerase inhibitor combination strategies in ovarian cancer[J]. Curr Opin Obstet Gynecol,2018,30(1)∶7-16.
[2] Chen W,Zheng R,Baade PD,et al. Cancer statistics in China,2015[J]. CA Cancer J Clin,2016,66(2)∶115-132.
[3] Siegel RL,Miller KD,Jemal A. Cancer statistics,2018[J]. CA Cancer J Clin. 2018,68(1)∶7-30.
[4] Utrilla-Layna J,Zapardiel I. Are we ready for conservative treatment in ovarian cancer?[J]. J Gynecol Oncol,2015,26(1)∶75-76.
[5] Prat J. New insights into ovarian cancer pathology[J]. Ann Oncol,2012,23(suppl10)∶x111-x117.
[6] Desai A,Xu J,Aysola K,et al. Epithelial ovarian cancer∶An overview[J]. World J Transl Med,2014,3(1)∶1-8
[7]魏旭,张国楠.早期上皮性卵巢癌术后辅助化疗及疗程对其预后的影响[J].肿瘤预防与治疗,2017,30(2)∶143-147.
[8] Panici PB,Marchetti C,Salerno L,et al. Dualistic classification of epithelial ovarian cancer∶surgical and survival outcomes in a large retrospective series[J]. Ann Surg Oncol,2014,21(9)∶3036-3041.
[9] Devouassoux-Shisheboran M,Genestie C,Ray-Coquard I. Dualistic classification of epithelial ovarian cancer∶Is it clinically relevant?[J]. Bull Cancer,2016,103(3)∶252-258.
[10]王玉.年轻Ⅰ期上皮性卵巢癌患者保留生育功能治疗的预后及妊娠结局Meta分析[D].南昌∶南昌大学,2018.
[11] Frielink LMJ,Pijlman BM,Ezendam NPM,et al. Clinical practice of adjuvant chemotherapy in patients with early-stage epithelial ovarian cancer[J]. Chemotherapy,2016,61(6)∶287-294.
[12] Romanidis K,Nagorni EA,Halkia E,et al. The role of cytoreductive surgery in advanced ovarian cancer∶the general surgeon's perspective[J]. J BUON,2014,19(3)∶598-604.
[13] Dong X,Men X,Zhang W,et al. Advances in tumor markers of ovarian cancer for early diagnosis[J]. Indian J Cancer,2014,51(Suppl 3)∶e72-e76.
[14] Yi H,Ye J,Yang XM,et al. High-grade ovarian cancer secreting effective exosomes in tumor angiogenesis[J]. Int J Clin Exp Pathol,2015,8(5)∶5062-5070.
[15] Shimada T,Saito T,Shimokawa M,et al. Improvement in the prognosis of ovarian cancer in the era before addition of molecular targeting therapy[J]. Jpn J Clin Oncol,2017,47(6)∶494-498.
[16] Men CD,Liu QN,Ren Q. A prognostic 11 genes expression model for ovarian cancer[J]. J Cell Biochem,2018,119(2)∶1971-1978.
[17] Satoh T,Yoshikawa H. Fertility-sparing surgery for early stage epithelial ovarian cancer[J]. Jpn J Clin Oncol,2016,46(8)∶703-710.
[18] Bentivegna E,Maulard A,Miailhe G,et al. Gynaecologic cancer surgery and preservation of fertility[J]. J Visc Surg,2018,155(suppl 1)∶s23-s29.
[19] Bergamini A,Petrone M,Rabaiotti E,et al. Fertility sparing surgery in epithelial ovarian cancer in Italy∶perceptions,practice,and main issues[J]. Gynecol Endocrinol,2017,34(4)∶305-308.
[20]中华医学会妇科肿瘤学分会.妇科恶性肿瘤保留生育功能临床诊治指南[J].中华妇产科杂志,2014,49(4)∶243-248.
[21] Ditto A,Martinelli F,Lorusso D,et al. Fertility sparing surgery in early stage epithelial ovarian cancer[J]. J Gynecol Oncol,2014,25(4)∶320-327.
[22]江彩霞,程忠平,万悦竹,等.腹腔镜与开腹手术在早期卵巢癌全面分期手术中的疗效和并发症比较[J].国际妇产科学杂志,2016,43(5)∶528-538.
[23] Zapardiel I,Diestro MD,Aletti G. Conservative treatment of early stage ovarian cancer∶oncological and fertility outcomes[J]. Eur J Surg Oncol,2014,40(4)∶387-393.
[24] Bentivegna E,Morice P,Uzan C,et al. Fertility-sparing surgery in epithelial ovarian cancer.[J]. Ann Oncol,2016,12(3)∶389-398.
[25] Park JY,Heo EJ,Lee JW,et al. Outcomes of laparoscopic fertility-sparing surgery in clinically early-stage epithelial ovarian cancer[J]. J Gynecol Oncol,2016,27(2)∶e20.
[26] Fruscio R,Ceppi L,Corso S,et al. Long-term results of fertilitysparing treatment compared with standard radical surgery for earlystage epithelial ovarian cancer[J]. Br J Cancer,2016,115(6)∶641-648.
[27] Hedbck NE,Karlsen MA,Hgdall CK,et al. Survival of selected patients with ovarian cancer treated with fertility-sparing surgery[J]. Reprod Biomed Online,2018,37(1)∶71-76.
[28] Berveiller P,Carbonne B,Mir O. Cancer and pregnancy∶an overview for obstetricians and gynecologists[J]. Am J Obstet Gynecol,2014,211(1)∶82.
[29] Germana T,Mario C,Monica R,et al. Prognostic factors in earlystage ovarian cancer[J]. Ecancermedicalscience,2013,7∶325-341.
[30] Fotopoulou C,Braicu I,Sehouli J. Fertility-sparing surgery in early epithelial ovarian cancer∶a viable option?[J]. Obstet Gynecol Int,2012,2012∶1-8.
[31] Letourneau J,Chan J,Salem W,et al. Fertility sparing surgery for localized ovarian cancers maintains an ability to conceive,but is associated with diminished reproductive potential[J]. J Surg Oncol,2015,112(1)∶26-30.
[32]张颖,杨佳欣,曹冬焱,等.早期上皮性卵巢癌保留生育功能手术患者预后与妊娠状况的影响因素[J].山东大学学报(医学版),2018,56(5)∶13-17.
[33] Schüring AN,Fehm T,Behringer K,et al. Practical recommendations for fertility preservation in women by the Ferti PROTEKT network. Part I∶Indications for fertility preservation[J]. Arch Gynecol Obstet,2018,297(1)∶241-255.
[34] Martínez F,Devesa M,Coroleu B,et al. Cancer and fertility preservation∶Barcelona consensus meeting[J]. Gynecol Endocrinol,2013,29(4)∶285-291.
[35] Feichtinger M,Rodriguezwallberg KA. Fertility preservation in women with cervical,endometrial or ovarian cancers[J]. Gynecol Oncol Res Pract,2016,3(1)∶8.
[36]祝洪澜,崔恒.卵巢恶性肿瘤保留生育功能后化疗的策略及卵巢保护[J].实用妇产科杂志,2016,32(11)∶807-809.
[37]王新宇,谢幸.上皮性卵巢癌保留生育功能治疗[J].中国实用妇科与产科杂志,2012,28(3)∶172-174.
[38] Cordeiro CN,Gemignani ML. Gynecologic malignancies in pregnancy∶balancing fetal risks with oncologic safety[J]. Obstet Gynecol Surv,2017,72(3)∶184-193.
[39] Blumenfeld Z,Zur H,Dann EJ. Gonadotropin-releasing hormone agonist cotreatment during chemotherapy may increase pregnancy rate in survivors[J]. Oncologist,2015,20(11)∶1283-1289.
[40] Lambertini M,Ceppi M,Poggio F,et al. Ovarian suppression using luteinizing hormone-releasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients∶a meta-analysis of randomized studies[J]. Ann Oncol,2015,51(12)∶2408-2419.
[41] Demeestere I,Turan V,Oktay K. Pregnancy rate and preservation of cyclic ovarian function with gonadotropin-releasing hormone agonist cotreatment during chemotherapy-reply[J]. JAMA Oncol,2016,2(4)∶546-547.
[42] Blumenfeld Z,Evron A. Preserving fertility when choosing chemotherapy regimens-the role of gonadotropin-releasing hormone agonists[J]. Expert Opin Pharmacother,2015,16(7)∶1009-1020.
[43] Yang B,Yu Y,Chen J,et al. Possibility of women treated with fertility-sparing surgery for non-epithelial ovarian tumors to safely and successfully become pregnant-a Chinese retrospective cohort study among 148 cases[DB/OL]. https://doi. org/10. 1007/s11684-017-0554-3,2017-12-07.
[44] Srikanthan A,Amir E,Bedard P,et al. Fertility preservation in post-pubescent female cancer patients∶A practical guide line for clinicians[J]. Mol Clin Oncol. 2018; 8(1)∶153-158.
[45] Maclaughlin DT,Donahoe PK. Müllerian inhibiting substance/antiMüllerian hormone∶a potential therapeutic agent for human ovarian and other cancers[J]. Future Oncol,2010,6(3)∶391-405.
[46] Wong RR,Jr WM,Chung TK,et al. An update on Mullerian-inhibiting substance∶its potential application against ovarian cancer[J]. Endocr Relat Cancer,2014,21(3)∶R227-R233.
[47] Di CT,Casorelli A,Morrocchi E,et al. Fertility management for malignant ovarian germ cell tumors patients[J]. Crit Rev Oncol Hematol,2017,120∶34-42.
[48] Papa A,Caruso D,Strudel M,et al. Update on poly-ADP-ribose polymerase inhibition for ovarian cancer treatment[J]. J Transl Med,2016,14(1)∶267-285.
[49] Mccann KE. Novel poly-ADP-ribose polymerase inhibitor combination strategies in ovarian cancer[J]. Curr Opin Obstet Gynecol,2018,30(1)∶7-16.
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