Meta-Analysis Of Gonadotropin-Releasing Hormone Agonists For Premenopausal Women Ovarian Function Protection During Chemotherapy

Background:The incidence of malignant diseases in young women tends to increase year by year,and many people have not had children when they are diagnosed with the disease.At the same time,contemporary women are increasingly demanding quality of life.In addition,more and more patients hope that both cancer treatment and ovarian function protection can be taken into account in the course of treatment.A considerable number of patients in clinical work have begun to use gonadotropin releasing hormone agonists(GnRHa)to protect ovarian reserve function,but there are different degrees of objection to the results of various clinical treatments,especially the lack of more comprehensive and relevant data analysis.Objective:To systematically evaluate the effectiveness of gonadotropin-releasing hormone agonists(GnRHa)in protecting ovarian function in premenopausal women before and/or during chemotherapy,we systematically analyzed the data and compared the use of gonadotropin-releasing hormone agonists before and/or during chemotherapy and during chemotherapy alone.Methods:Using the Internet to search the US National Library PubMed database,Cochrane Library,MEDLINE,CENTRAL,Chinese biomedical literature data system SinoMed,China Knowledge Network CNKI database,Google Scholar,CQVIP,collect GnRHa clinical randomized controlled trial of ovarian function protection in women with non-menopausal chemotherapy(RCT).RevMan5.3 software was used to comprehensively analyze the incidence of early onset ovarian insufficiency(POI),menstrual recovery rate,pregnancy rate and other indicators.Results:Twelve eligible literatures were included,of which 1 509 were premenopausal women with malignant diseases requiring chemotherapy,768 in the experimental group and 741 in the control group.GnRHa + chemotherapy can effectively reduce the incidence of POI(OR = 0.36,95% CI 0.23-0.56,P < 0.01),improve the menstrual recovery rate(OR = 2.49,95% CI 1.72-3.60,P < 0.01),GnRHa combined with chemotherapy may increase the pregnancy rate(OR = 1.65,95% CI 1.06-2.55,P = 0.03).However,according to the analysis of different age subgroups,there was no significant difference in the incidence of P OI between the two groups(OR = 0.42,95% CI0.07-2.54,P = 0.35).There was no significant difference in the menstrual recovery rate between the two groups(OR = 3.42,95% CI 0.74-15.74,P = 0.11),and there was no significant difference in the pregnancy rate between the two groups(OR = 1.19,95% CI0.57-2.48,P = 0.65,P > 0.05).The data showed that GnRHa + chemotherapy could reduce POI incidence after chemotherapy(OR = 0.35,95% CI 0.25-0.49,P < 0.01),increase menstrual recovery rate(OR = 3.42,95% CI 1.69-3.19,P < 0.01),and increase pregnancy rate(OR = 2.04,95% CI 1.08-3.83,P = 0.03).Chemotherapy plus GnRHa can improve the menstrual recovery rate within 2 years of follow-up after chemotherapy,but there is no significant difference in the menstrual recovery rate after long-term follow-up of more than 3 years.At the same time,the evaluation quality level of each study did not affect the results of this Meta-analysis.Conclusion:The administration of GnRHa before and/or during chemotherapy may prevent the damage of ovarian function caused by chemotherapy,reduce the incidence of POI,and improve the menstrual recovery rate and pregnancy rate.