Longitudinal trends in testicular volume z scores from puberty to adulthood, sperm quality, and paternity outcomes after childhood cancer

IF 6.1 2区 医学 Q1 ONCOLOGY
Cancer Pub Date : 2024-10-29 DOI:10.1002/cncr.35623
Melanie Korhonen MD, Kirsi Jahnukainen MD, PhD, Mikael Koskela MD, PhD
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Abstract

Background

Childhood cancer therapy may cause subfertility. This study correlated cancer therapy exposures with testicular volumes from puberty to adulthood, spermatogenesis, and paternity outcomes in adulthood.

Methods

The study population comprised 255 male childhood cancer survivors (CCS) (survival ≥5 years, diagnosed in 1964–2000 at the Helsinki Children's Hospital) whose testicular volume was measured at ages 12 years (n = 38), 14 years (n = 57), 16 years (n = 63), 18 years (n = 105), and in adulthood (n = 43; median age, 27 years). Testicular volumes were converted to age-specific z scores. In addition, 92 CCS provided semen sample in adulthood (median age, 25.2 years); and paternity was evaluated through national register data (mean age at assessment, 37.6 years; n = 252).

Results

Compared with age-specific reference values, CCS generally exhibited low testicular volume z scores at ages 12–18 years. Testicular volume z scores in CCS treated exclusively with chemotherapy returned to the reference range in adulthood. In contrast, patients exposed to testicular radiation ≥1 gray (Gy) (median dose, 12 Gy) showed no late recovery in testicular size. Testicular radiation ≥1 Gy and a cyclophosphamide equivalent dose ≥12 g/m2 were identified as risk factors for azoospermia in adulthood. Patients exposed to testicular radiation ≥1 Gy and a cyclophosphamide equivalent dose ≥4 g/m2 had lower paternity rates.

Conclusions

Testicular volume growth after prolonged follow-up suggests a potential late recovery of spermatogenesis in CCS treated exclusively with chemotherapy. However, alkylating agents increased the risk of having prolonged azoospermia and nonpaternity. High-dose testicular radiation causes long-term depletion of spermatogonia and was the strongest risk factor for azoospermia and nonpaternity.

Abstract Image

从青春期到成年期睾丸体积 Z 值的纵向趋势、精子质量以及儿童癌症后的亲子关系结果。
背景:儿童时期接受癌症治疗可能会导致不育。本研究将癌症治疗暴露与青春期至成年期的睾丸体积、精子发生以及成年后的亲子关系结果联系起来:研究对象包括 255 名男性儿童癌症幸存者(CCS)(存活时间≥5 年,1964-2000 年在赫尔辛基儿童医院确诊),他们的睾丸体积分别在 12 岁(38 个)、14 岁(57 个)、16 岁(63 个)、18 岁(105 个)和成年时(43 个;中位年龄 27 岁)进行了测量。睾丸体积被转换为特定年龄的 Z 值。此外,92 名 CCS 提供了成年期精液样本(年龄中位数为 25.2 岁);亲子鉴定通过国家登记数据进行(评估时的平均年龄为 37.6 岁;n = 252):结果:与特定年龄的参考值相比,12-18 岁儿童的睾丸体积 z 值普遍较低。完全接受化疗的儿童睾丸体积 Z 值在成年后恢复到参考值范围。相比之下,接受睾丸辐射≥1灰度(Gy)(中位剂量为12 Gy)的患者的睾丸体积在后期没有恢复。睾丸辐射≥1 Gy和环磷酰胺当量剂量≥12 g/m2被确定为成年期无精子症的风险因素。接受睾丸辐射≥1 Gy和环磷酰胺当量剂量≥4 g/m2的患者的父亲率较低:长期随访后的睾丸体积增长表明,只接受化疗的CCS患者精子发生可能会在晚期恢复。然而,烷化剂会增加长期无精子症和不育的风险。高剂量睾丸辐射会导致精原细胞长期耗竭,是导致无精子症和不育的最主要风险因素。
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
Cancer
Cancer 医学-肿瘤学
CiteScore
13.10
自引率
3.20%
发文量
480
审稿时长
2-3 weeks
期刊介绍: The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society. CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research
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