A Meta-analysis Of The Effect Of Gonadotropin Releasing Hormone Agonist On Menstruation And Fertility In Premenopausal Breast Cancer Patients During Chemotherapy

BACKGROUND: Premenopausal breast cancer patients more and more attention during chemotherapy leads to premature ovarian failure and infertility.A potential strategy for the protection of ovarian function is the use of gonadotropin-releasing hormone agonists(GnRHa)during chemotherapy.However,the clinical efficacy of the study is different,and the lack of data on Fertility Analysis.OBJECTIVE: This meta-analysis study was designed to evaluate the effect of chemotherapy combined with gonadotropin releasing hormone agonist on ovarian function in premenopausal breast cancer patients.In order to provide reference for clinical decision-making and Practice.METHODS: Electronic databases Pubmed,MEDLINE,EMBASE,China National Knowledge Infrastructure,the Wanfang data and web of Science were searched for relevant randomized controlled trials(RCTs)published until December 2015.Randomized controlled trial of the use of gonadotropin-releasing hormone analogues in the prevention and treatment of ovarian function and fertility in premenopausal breast cancer patients during chemotherapy is limited to English and Chinese Literature.Two researchers independently completed the literature screening,data extraction,literature quality evaluation process,using RevMan5.0 and Stata 11 statistical software for Meta analysis.RESULTS: A total of 9 randomized controlled trials involving a total of858 premenopausal patients with breast cancer were included in the meta-analysis.Among them,chemotherapy combined with GnRHa was performed in 442 patients and chemotherapy alone was 416.A significantly great number of premenopausal breast cancer patients on the rate of spontaneous resumption of mense was higher than that ofChemotherapy alone group(OR=2.63,95% confidence interval(CI)=[1.50,4.63],P=0.0008).However,there was no statistically significant difference in the rate of spontaneous pregnancy between the chemotherapy combined with Gn RHa group and the chemotherapy alone group(OR=1.77,95%CI=[0.92,3.40];P=0.09).Among the young patients aged <40 years,the use of GnRH agonists had statistical significance for the rate of spontaneous resumption of mense(OR=2.26,95%CI=1.07,4.75;P=0.03).Rather than no statistical significance over 40 years old breast cancer patients(OR=1.84,95%CI=0.78,4.35;P=0.16).There was no statistical significance for the combination of tamoxifen and Gn RHa and tamoxifen alone(OR=1.45,95%CI=[0.90,2.33];P=0.12);(OR=1.44,95%CI=[0.91,2.30];P=0.12).Anthracycline based chemotherapy combined with Gn RHa was statistically significant for the rate of spontaneous resumption of mense(OR=2.49,95%CI=[1.06,5.89];P=0.04).Analysis of subgroups of adverse reactions to chemotherapy +GnRHa group significantly increased hot flashes(OR=1.92,95%CI=[1.26,2.93];P=0.002).However,for vaginal dryness,decreased libido and mood changes were not statistically significant in the experimental group and control group,results wereOR=1.46,95%CI=[0.69,3.10];P=0.32),(OR=1.44,95%CI=[0.67,3.09];P=0.35),(OR=1.55,95%CI=[0.68,3.53];P=0.29.CONCLUSION:GnRHa improves menstrual cycle rates in premenopausal breast cancer patients after chemotherapy,the results suggest that ovarian function can be effectively protected,but the benefit of natural pregnancy cannot be confirmed.The need for more large sample,multicenter,randomized controlled trials of high quality,homogeneity to further confirmed the safety and efficacy of GnRHa.