使用接受烷化劑藥物累積劑量預測化學治療後無精症男性接受顯微取精手術之結果

蔡仕傑¹、黃奕燊^{1, 2}、黃志賢^{1, 2}

¹臺北榮民總醫院泌尿部；²國立陽明交通大學醫學系泌尿學科及書田泌尿科學研究中心

Prediction of microdissection testicular sperm extraction outcome in post-chemotherapy azoospermic men using cyclophosphamide equivalent dose

Shi-Jie Tsai¹, I-Shen Huang^{1, 2}, William J.S. Huang^{1, 2}

¹ Department of Urology, Taipei Veterans General Hospital, Taiwan

²Department of Urology, School of Medicine, College of Medicine, Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Purpose:

Cancer per se or therapies, particularly treatment involved with chemotherapy, appears to potentiate gonadal toxicity. For men with persistent postchemotherapy azoospermia, fatherhood can be possibly achieved via microdissection testicular sperm extraction (mTESE) combine with intracytoplasmic sperm injection (ICSI). Yet, the recovery of viable testicular sperm with mTESE is unpredictable in this population. Using cyclophosphamide equivalent dose (CED) as a means of quantifying exposure to alkylating agent, a cytotoxic agent that has been demonstrated to disrupt spermatogenesis, we sought to discover the sperm retrieval rate in men with persistent azoospermia postchemotherapy in relation to CED.

Materials and Methods:

We retrospectively reviewed the medical records of 1098 patients with the diagnosis of non-obstructive azoospermia who had undergone the mTESE between January 2010 to February 2020 in our institution and enrolled 16 patients with a prior history of chemotherapy. The oncological data, chemotherapy regimen, and dosage of each individual were reviewed. For each patient’s regimen received, a CED was calculated using the equation proposed by Daniel Green et al. in 2014. The pretreatment hormone profile, CED, and outcomes of mTESE were analyzed. Statistical analyses were performed using the Mann-Whitney U test or Fisher’s exact test.

 Results:

Testicular spermatozoa were successfully retrieved in 7 (43%) of the patients. The mean patient age was 36.4 years (range, 27-42 years) and the mean time interval from chemotherapy to mTESE was 9.6 years (range, 1-26 years). Patients with alkylating agent exposure had significantly lower sperm retrieval rate (0/5, 0%) versus those not exposed to alkylating agent (7/11, 64%, p=0.03). Although CED was not predictive factors for successful sperm retrieval (p=0.07), however, no men with CED > 4000 mg/m² (n=4) had viable sperm detected in testis during mTESE. Regarding cancer subtypes, patients diagnosed with testicular non-seminomatous germ cell tumor had favorable sperm retrieval rate (3/5, 60%), compared to patients with non-Hodgkin’s lymphoma (0/3, 0%) or leukemia (1/2, 50%), respectively.

Conclusions:

The chance of successful sperm retrieval using mTESE for men with persistent postchemotherapy azoospermia and a calculated CED > 4000 mg/m² is zero. These patients should be properly counseled with the CED model before pursuing surgical sperm retrieval.