Effect of chemotherapy on ovarian function in young patients with malignant germ cell tumors of the ovary after conservative surgery / 中国综合临床

ABSTRACT

Objective To investigate the effect of chemotherapy on ovarian function in young patients with malignant germ cell tumors of the ovary after conservative surgery.Methods 15 patients (11～29 years old) with ovarian malignant germ cell tumors were treated by ovarectomy and the following chemotherapy.Their menstruation and serum follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2) levels and basal antral follicle(F0) numbers were observed from the duration of chemotherapy to one year after chemotherapy.The serum levels of FSH,LH,E2 and basal antral follicle numbers between the chemotherapy-related amenorrhea(CRA) patients and the patients with benign tumors of ovary who underwent unilateral adnexa removed at the same period(control group,n=10) were compared.Results Oligomenstruation occurred in 13 of 15 cases undergoing chemotherapy after conservative surgery(86.7%),in whom CRA occurred in 10 cases(66.7%) at the duration of 4-6 cycle chemotherapy appearing significantly rising serum level of FSH,LH and declining serum E2 level and F0 numbers.There was a significantly positive correlation between the frequency of amenorrhea and the duration of chemotherapy(r=1.000,P=0.01).Generally menstruation resumed around 2～3 months after chemotherapy.Ahhough the serum levels of sexual hormone seemed to be normal at half a year after chemotherapy in CRA patients,the serum FSH(8.30±1.46 mU/ml) and E2(80.50±7.86 ng/L) level were significantly increased as compared with that of the control group and the reverse was found in Fo numbers(3.80±1.04) (t Fo,FsH,E2=7.660,5.277,7.225;P F0,FSH,E2<0.001,<0.001,<0.001).One year after chemotherapy,serum hormone level and the ovary reserve function of the CRA patient came to be normal[FSH=(5.59±0.52)mU/ml,LH=(5.25±0.84)mU/ml,E2=(56.50±5.13)ng/L,Fo=(6.50±1.08)] and that of control group [FSH=(5.43±0.35)mU/ml,LH=(5.17±0.48)mU/ml,E2=(58.10±3.73)ng/L,F0=(6.60±0.97)](t=1.177,0.694,0.505,0.740;P>0.05,>0.05,>0.05,P>0.05).Conclusions Ovarian function impairment may occur in young patients in adolescence and sexual maturity period with ovarian malignant germ cell tumors who were treated by conservative surgery followed by chemotherapy.Although the CRA is reversible,the recovery of menstruation does not meail the recovery of ovarian funetion.because the ovarian impairment may continue to a duration of half a year after chemotherapy.The drug which can safeguard ovariall function should be considered during chemotherapy.