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Predicting acute ovarian failure in female survivors of childhood cancer: a cohort study in the Childhood Cancer Survivor Study (CCSS) and the St Jude Lifetime Cohort (SJLIFE).
Clark, Rebecca A; Mostoufi-Moab, Sogol; Yasui, Yutaka; Vu, Ngoc Khanh; Sklar, Charles A; Motan, Tarek; Brooke, Russell J; Gibson, Todd M; Oeffinger, Kevin C; Howell, Rebecca M; Smith, Susan A; Lu, Zhe; Robison, Leslie L; Chemaitilly, Wassim; Hudson, Melissa M; Armstrong, Gregory T; Nathan, Paul C; Yuan, Yan.
Afiliação
  • Clark RA; School of Public Health, University of Alberta, Edmonton, AB, Canada.
  • Mostoufi-Moab S; University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
  • Yasui Y; St Jude Children's Research Hospital, Memphis, TN, USA.
  • Vu NK; School of Public Health, University of Alberta, Edmonton, AB, Canada.
  • Sklar CA; Memorial Sloan Kettering Cancer Center, New York, NY, USA.
  • Motan T; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
  • Brooke RJ; St Jude Children's Research Hospital, Memphis, TN, USA.
  • Gibson TM; St Jude Children's Research Hospital, Memphis, TN, USA.
  • Oeffinger KC; Duke University School of Medicine, Durham, NC, USA.
  • Howell RM; The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Smith SA; The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Lu Z; School of Public Health, University of Alberta, Edmonton, AB, Canada.
  • Robison LL; St Jude Children's Research Hospital, Memphis, TN, USA.
  • Chemaitilly W; St Jude Children's Research Hospital, Memphis, TN, USA.
  • Hudson MM; St Jude Children's Research Hospital, Memphis, TN, USA.
  • Armstrong GT; St Jude Children's Research Hospital, Memphis, TN, USA.
  • Nathan PC; The Hospital for Sick Children, Toronto, ON, Canada.
  • Yuan Y; School of Public Health, University of Alberta, Edmonton, AB, Canada. Electronic address: yyuan@ualberta.ca.
Lancet Oncol ; 21(3): 436-445, 2020 03.
Article em En | MEDLINE | ID: mdl-32066539
BACKGROUND: Cancer treatment can cause gonadal impairment. Acute ovarian failure is defined as the permanent loss of ovarian function within 5 years of cancer diagnosis. We aimed to develop and validate risk prediction tools to provide accurate clinical guidance for paediatric patients with cancer. METHODS: In this cohort study, prediction models of acute ovarian failure risk were developed using eligible female US and Canadian participants in the Childhood Cancer Survivor Study (CCSS) cohort and validated in the St Jude Lifetime Cohort (SJLIFE) Study. 5-year survivors from the CCSS cohort were included if they were at least 18 years old at their most recent follow-up and had complete treatment exposure and adequate menstrual history (including age at menarche, current menstrual status, age at last menstruation, and menopausal aetiology) information available. Participants in the SJLIFE cohort were at least 10-year survivors. Participants were excluded from the prediction analysis if they had an ovarian hormone deficiency, had missing exposure information, or had indeterminate ovarian status. The outcome of acute ovarian failure was defined as permanent loss of ovarian function within 5 years of cancer diagnosis or no menarche after cancer treatment by the age of 18 years. Logistic regression, random forest, and support vector machines were used as candidate methods to develop the risk prediction models in the CCSS cohort. Prediction performance was evaluated internally (in the CCSS cohort) and externally (in the SJLIFE cohort) using the areas under the receiver operating characteristic curve (AUC) and the precision-recall curve (average precision [AP; average positive predictive value]). FINDINGS: Data from the CCSS cohort were collected for participants followed up between Nov 3, 1992, and Nov 25, 2016, and from the SJLIFE cohort for participants followed up between Oct 17, 2007, and April 16, 2012. Of 11 336 female CCSS participants, 5886 (51·9%) met all inclusion criteria for analysis. 1644 participants were identified from the SJLIFE cohort, of whom 875 (53·2%) were eligible for analysis. 353 (6·0%) of analysed CCSS participants and 50 (5·7%) of analysed SJLIFE participants had acute ovarian failure. The overall median follow-up for the CCSS cohort was 23·9 years (IQR 20·4-27·9), and for SJLIFE it was 23·9 years (19·0-30·0). The three candidate methods (logistic regression, random forest, and support vector machines) yielded similar results, and a prescribed dose model with abdominal and pelvic radiation doses and an ovarian dose model with ovarian radiation dosimetry using logistic regression were selected. Common predictors in both models were history of haematopoietic stem-cell transplantation, cumulative alkylating drug dose, and an interaction between age at cancer diagnosis and haematopoietic stem-cell transplant. External validation of the model in the SJLIFE cohort produced an estimated AUC of 0·94 (95% CI 0·90-0·98) and AP of 0·68 (95% CI 0·53-0·81) for the ovarian dose model, and AUC of 0·96 (0·94-0·97) and AP of 0·46 (0·34-0·61) for the prescribed dose model. Based on these models, an online risk calculator has been developed for clinical use. INTERPRETATION: Both acute ovarian failure risk prediction models performed well. The ovarian dose model is preferred if ovarian radiation dosimetry is available. The models, along with the online risk calculator, could help clinical discussions regarding the need for fertility preservation interventions in girls and young women newly diagnosed with cancer. FUNDING: Canadian Institutes of Health Research, Women and Children's Health Research Institute, National Cancer Institute, and American Lebanese Syrian Associated Charities.
Assuntos

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Insuficiência Ovariana Primária / Medição de Risco / Sobreviventes de Câncer / Neoplasias Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Child / Female / Humans País como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Insuficiência Ovariana Primária / Medição de Risco / Sobreviventes de Câncer / Neoplasias Tipo de estudo: Etiology_studies / Guideline / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Child / Female / Humans País como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article