中国首例乳腺癌患者冻存卵巢组织移植成功报道及文献复习

doi:10.3969/j.issn.1006-7795.2021.02.002

首都医科大学学报 ›› 2021, Vol. 42 ›› Issue (2): 177-182.doi: 10.3969/j.issn.1006-7795.2021.02.002

中国首例乳腺癌患者冻存卵巢组织移植成功报道及文献复习

阮祥燕^1,*, 杨瑜¹, 卢丹², 杜娟¹, 程姣姣¹, 谷牧青¹, 李扬璐¹, 金凤羽¹, 段微³, 代荫梅¹, 鞠蕊¹, 许新¹, MatthiasKorell⁴, AlfredO.Mueck^1,5

1. 首都医科大学附属北京妇产医院内分泌科, 北京 100026;
2. 首都医科大学附属北京妇产医院妇科, 北京 100026;
3. 首都医科大学附属北京妇产医院妇科肿瘤科, 北京 100026;
4. 德国诺伊斯约翰娜艾蒂安医院, 诺伊斯 41462, 德国;
5. 德国图宾根大学妇产医院妇女健康部与妇女健康研究中心,图宾根 D-72076, 德国

收稿日期:2020-02-22 发布日期:2021-04-26
基金资助:
北京市自然科学基金(7202047),首都卫生发展科研专项项目(首发2020-2-2112,2016-2-2113),北京市医院管理局临床医学发展专项经费资助(XMLX201710),首都临床特色应用研究课题(Z161100000516143),北京市医院管理局“登峰”计划专项(DFL20181401),2018年度国家外专局引智重点项目(20181100005),中国国际人才交流促进会医疗健康技术创新与人才培养专项基金(2017041900004,2018042000001)

The first successful case report of breast cancer patient's cryopreserved ovarian tissue transplantation in China and literature review

Ruan Xiangyan^{1, *}, Yang Yu¹, Lu Dan², Du Juan¹, Cheng Jiaojiao¹, Gu Muqing¹, Li Yanglu¹, Jin Fengyu¹, Duan Wei³, Dai Yinmei¹, Ju Rui¹, Xu Xin¹, Matthias Korell⁴, Alfred O. Mueck⁵

1. Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China;
2. Department of Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China;
3. Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China;
4. Johanna-Etienne Hospital in Neuss, Neuss 41462, Germany;
5. Department of Women's Health, University Women's Hospital and Research Centre for Women's Health, University of Tuebingen, Tuebingen D-72076, Germany;

Received:2020-02-22 Published:2021-04-26
Contact: ^*E-mail:ruanxiangyan@ccmu.edu.cn
Supported by:
This study was supported by Natural Science Foundation of Beijing (7202047),Beijing Capital Foundation for Medical Science Development and Research (2020-2-2112,2016-2-2113),Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (XMLX201710),Foundation of Beijing Municipal Science and Technology Commission (Z161100000516143),Beijing Municipal Administration of Hospitals' Ascent Plan (DFL20181401),SAFEA: Project for Key Foreign Experts (20181100005),Beijing Municipal Health Commission,China International Talent Exchange Association Medical Health Technology Innovation and Talent Training Special Fund (2017041900004,2018042000001).

摘要/Abstract

摘要： 目的卵巢组织冻存移植防治乳腺癌患者医源性早发性卵巢功能不全(premature ovarian insufficiency,POI)。方法患者35岁,乳腺浸润性导管癌T_1CN₂M₀,雌激素受体α(estrogen receptor α,ERα)(-),孕激素受体(progestone receptor,PR)(-)。在乳腺癌改良根治术后行部分卵巢组织冻存,冻存后开始乳腺癌规范的个体化放射治疗、化学药物治疗和靶向治疗。治疗结束1年后,患者闭经1年多、绝经症状明显,经乳腺专家会诊评估,患者处于无瘤存活状态,且患者卵巢功能检测:卵泡刺激素(follicle stimulating hormone,FSH)101.83 IU/L,抗苗勒管激素(anti-Müllerian hormone,AMH)<0.06 ng/mL,以上检测结果证明患者的卵巢功能已彻底衰退,需要进行冻存卵巢组织移植,患者自身条件也允许,随后进行了移植。结果移植后2个月,患者绝经症状消失,FSH 7.29 IU/L,经阴道B超检测,移植的卵巢有卵泡发育并可自行排卵。移植后3个月,患者月经来潮,证明患者卵巢功能恢复正常,冻存卵巢组织移植成功。现患者移植近3年,卵巢功能正常。结论这是中国首例乳腺癌患者卵巢组织冻存移植成功的报道,卵巢组织冻存移植为防治医源性POI保护生育力提供了一种重要的新技术,本文就此报道并进行文献复习。

关键词: 卵巢组织冻存, 移植, 乳腺癌, 防治, 医源性早发性卵巢功能不全

Abstract: Objective To prevent and treat iatrogenic premature ovarian insufficiency in breast cancer patient by ovarian tissue cryopreservation and transplantation.Methods Ovarian tissue cryopreservation was performed after modified radical mastectomy in a 35-year-old breast invasive ductal carcinoma [estrogen receptor α(ERα)(-), progestone receptor(PR)(-),T_1CN₂M₀] patient. Subsequently,normative and individual radiotherapy,chemotherapy and targeted therapy were performed. During and after tumor therapy,she had got amenorrhea for more than one year and experienced obvious menopause symptoms. She had been tumor-free survival consulted and evaluated by breast cancer experts. The ovarian function test showed that follicle stimulating hormone(FSH) was 101.83 IU/L and anti-Müllerian hormone(AMH) was less than 0.06 ng/mL. The data suggested that the patient's ovarian function was completely exhausted,and the patient needed and met the physical requirement for cryopreserved ovarian tissue transplantation. Consequently, the transplantation was performed. Results Two months after transplantation,the patient's menopause symptoms disappeared,FSH decreased to 7.29 IU/L, and transvaginal ultrasound showed follicular development and ovulation in the transplanted ovary. Three months after transplantation,her menstruation recovered, indicating that the patient's ovarian function was completely recovered and the cryopreserved ovarian tissue transplantation was successful. Up to now, the patient has been transplanted for nearly 3 years and the ovarian function remains normal. Conclusion This was the first successful case report of breast cancer patient cryopreserved ovarian tissue transplantation in China. Ovarian tissue cryopreservation and transplantation is a new important technology for prevention and treatment of iatrogenic premature ovarian insufficiency and fertility protection. This manuscript also reviews the literature on this issue.

Key words: ovarian tissue cryopreservation, transplantation, breast cancer, prevention-treatment, iatrogenic premature ovarian insufficiency

中图分类号:

R711.75

阮祥燕, 杨瑜, 卢丹, 杜娟, 程姣姣, 谷牧青, 李扬璐, 金凤羽, 段微, 代荫梅, 鞠蕊, 许新, MatthiasKorell, AlfredO.Mueck. 中国首例乳腺癌患者冻存卵巢组织移植成功报道及文献复习[J]. 首都医科大学学报, 2021, 42(2): 177-182.

Ruan Xiangyan, Yang Yu, Lu Dan, Du Juan, Cheng Jiaojiao, Gu Muqing, Li Yanglu, Jin Fengyu, Duan Wei, Dai Yinmei, Ju Rui, Xu Xin, Matthias Korell, Alfred O. Mueck. The first successful case report of breast cancer patient's cryopreserved ovarian tissue transplantation in China and literature review[J]. Journal of Capital Medical University, 2021, 42(2): 177-182.

参考文献

[1] Li T,Mello-Thoms C,Brennan P C.Descriptive epidemiology of breast cancer in China: incidence,mortality,survival and prevalence[J]. Breast Cancer Res Treat,2016,159(3):395-406.
[2] Fan L,Strasser-Weippl K,Li J J,et al.Breast cancer in China[J]. Lancet Oncol,2014,15(7):e279-e289.
[3] Pagani O,Partridge A,Korde L,et al.Pregnancy after breast cancer: if you wish,ma'am[J]. Breast Cancer Res Treatment,2011,129(2):309-317.
[4] 国际妇科内分泌学会中国妇科内分泌学分会及共识专家. 卵巢组织冻存与移植中国专家共识[J]. 中国临床医生杂志,2018,46(4):496-500.
[5] Ruan X,Cheng J,Korell M,et al.Ovarian tissue cryopreservation and transplantation prevents iatrogenic premature ovarian insufficiency: first 10 cases in China[J]. Climacteric,2020,23(6):574-580.
[6] Ruan X.Chinese Society of Gynecological Endocrinology affiliated to the International Society of Gynecological Endocrinology Guideline for ovarian tissue cryopreservation and transplantation[J]. Gynecol Endocrinol,2018,34(12):1005-1010.
[7] 阮祥燕,杜娟,卢丹,等. 中国首例冻存卵巢组织移植报告[J]. 首都医科大学学报,2016,37(6):840-842.
[8] 中国抗癌协会乳腺癌专业委员会.中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J]. 中国癌症杂志,2019,29(8):609-680.
[9] Beckmann M W,Lotz L,Toth B,et al.Concept paper on the technique of cryopreservation,removal and transplantation of ovarian tissue for fertility preservation[J]. Geburtshilfe Frauenheilkd,2019,79(1):53-62.
[10] 张巧利,吴瑞芳. 英国生育协会“医源性原因女性生育力保存策略与实践指南(2018版)”解读[J]. 中华生殖与避孕杂志,2020,40(4):344-345.
[11] NICE.Fertility problems: assessment and treatment[EB/OL].(2017-09-06) [2021-02-22].https://www.nice.org.uk/guidance/cg156?unlid=46855266201611595632.
[12] Lambertini M,Del Mastro L,Pescio M C,et al.Cancer and fertility preservation: international recommendations from an expert meeting[J]. BMC Med,2016,14(1):1-16.
[13] 杜娟,马飞,阮祥燕. 乳腺癌患者生育力保护的研究进展[J]. 中国临床医生杂志,2019,47(7):769-771.
[14] Bajpai J,Majumdar A,Satwik R,et al.Practical consensus recommendations on fertility preservation in patients with breast cancer[J]. South Asian J Cancer,2018,7(2):110-114.
[15] Gellert S E,Pors S E,Kristensen S G,et al.Transplantation of frozen-thawed ovarian tissue: an update on worldwide activity published in peer-reviewed papers and on the Danish Cohort[J]. J Assist Reprodu Gene,2018,35(4):561-570.
[16] Beckmann M W, Lotz L, Toth B, et al.Concept Paper on the Technique of Cryopreservation, Removal and Transplantation of Ovarian Tissue for Fertility Preservation[J]. Geburtshilfe Frauenheilkd,2019,79(1):53-62.

中国首例乳腺癌患者冻存卵巢组织移植成功报道及文献复习

The first successful case report of breast cancer patient's cryopreserved ovarian tissue transplantation in China and literature review

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	杨敏, 燕翔, 刘锡娟, 安国, 丁慧荣, 蔡英, 葛会争. 人肺癌细胞原位移植瘤小鼠模型免疫细胞的多色流式细胞术检测方法的建立[J]. 首都医科大学学报, 2023, 44(1): 99-106.
[2]	程姣姣, 阮祥燕, 杜娟, 谷牧青. 未成熟卵母细胞体外成熟在生育力保护中的应用进展[J]. 首都医科大学学报, 2022, 43(3): 329-335.
[3]	赵越, 阮祥燕, 程姣姣, 谷牧青, 许新, 王月姣. 乳腺癌中PGRMC1表达与临床病理参数的相关性[J]. 首都医科大学学报, 2022, 43(3): 350-356.
[4]	魏常胜, 骆成玉, 张树琦. 环乳晕切口联合乳腔镜腋窝淋巴结清扫在早期乳腺癌保乳手术中的应用[J]. 首都医科大学学报, 2021, 42(6): 1014-1020.
[5]	朱平, 禹环, 符丽梅, 廖欣, 熊暮珺, 雷阿明, 祝平安, 梁欣荃. 脐血移植治疗难治复发急性白血病的临床分析[J]. 首都医科大学学报, 2021, 42(6): 1041-1045.
[6]	李珊珊, 鲍会漳, 孙意, 王春燕, 贾玫. 降钙素原与骨髓移植后菌血症患者感染菌群特点及预后的相关性[J]. 首都医科大学学报, 2021, 42(5): 726-732.
[7]	程姣姣, 阮祥燕, 杜娟, 金凤羽, 李扬璐, 谷牧青. 卵巢组织冻存移植安全性的研究进展[J]. 首都医科大学学报, 2021, 42(4): 505-510.
[8]	王慧娟, 杨光忠, 菅原, 耿传营, 周慧星, 陈文明. VRD与VCD方案诱导治疗后序贯自体造血干细胞移植对新诊断的多发性骨髓瘤患者的疗效分析[J]. 首都医科大学学报, 2021, 42(4): 615-622.
[9]	孙熙木, 王华光, 赵昕, 吕少诚, 贺强, 刘丽宏. 肝移植患者术后巨细胞病毒感染的危险因素分析[J]. 首都医科大学学报, 2021, 42(4): 664-671.
[10]	中华预防医学会妇女保健分会; 中国人体健康科技促进会妇科内分泌与生育力促进专委会. 乳腺癌患者选择性雌激素受体调节剂治疗相关子宫内膜安全管理的中国专家共识(2021版)[J]. 首都医科大学学报, 2021, 42(4): 672-677.
[11]	庄虔莹, 王芹, 陈仝, 杨晓葵. 脱氢表雄酮对卵巢储备功能减退患者IVF结局及卵泡液GDF-9、BMP-15的影响[J]. 首都医科大学学报, 2021, 42(2): 188-193.
[12]	王超宇, 隗明, 刘永哲, 陈云霞, 谷丽. 肺内外隐球菌感染病例的临床特征分析[J]. 首都医科大学学报, 2021, 42(2): 328-333.
[13]	杨阳, 康骅, 赵菁, 凌煜玮, 赵烨, 王亚军, 戎冬冬. 术前乳腺MRI对乳腺癌保乳手术切缘评估的回顾性分析[J]. 首都医科大学学报, 2020, 41(6): 943-953.
[14]	张菊霞, 吴安石. 背驮式与经典非转流式肝移植围术期临床疗效的研究[J]. 首都医科大学学报, 2020, 41(6): 954-959.
[15]	程姣姣, 阮祥燕, 杜娟, 谷牧青. 间充质干细胞对人冻融卵巢组织移植后低氧期保护作用的研究进展[J]. 首都医科大学学报, 2020, 41(4): 536-541.