{"id":305,"title":"Fertility Preservation in Male Children, Adolescents, and Young Adults With Cancer: A Systematic Review and Appraisal of Guidelines","title_zh":"男性儿童、青少年与年轻癌症患者的生育力保存：指南系统评价与质量评估","url":"https://pubmed.ncbi.nlm.nih.gov/42976363","doi":"10.1097/ju.0000000000005380","pmid":"42976363","journal":"J Urol","kind":"paper","lang":"en","published_at":"2026-11-03T00:00:00+00:00","fetched_at":"2026-11-08T03:44:04+00:00","authors":["Fields E","Kaushal S","Maher S","Tadayon B","Hamilton RJ","Lo K","Jarvi K","Chua ME","Romao R","Lorenzo AJ","Khondker A"],"primary_topic":"fertility-preservation","topics":[{"slug":"fertility-preservation","score":6.0,"hits":["fertility preservation","gonadotoxic","gonadotoxicity"]},{"slug":"ethics-policy","score":6.0,"hits":["consensus","ethical","guidelines"]},{"slug":"male","score":1.0,"hits":["sperm"]},{"slug":"embryology-lab","score":1.0,"hits":["cryopreservation"]},{"slug":"repro-tox","score":1.0,"hits":["gonadotoxic"]}],"topic_score":6.0,"preference_score":0.0,"preference_labels":[],"llm_score":78.0,"final_score":78.0,"score_dims":{"novelty":62,"rigor":85,"impact":74,"relevance":88,"translation":80},"recommend_reason":"这是针对男性肿瘤患者生育力保存指南的系统评价，方法规范（AGREE II、28个条目一致性分析），明确指出现有指南在伦理与流程层面的空白，对临床路径建设和后续标准化研究有直接参考价值。","keywords":["生育力保存","男性癌症患者","指南系统评价","AGREE II","精子冷冻保存","性腺毒性"],"selected":1,"story_id":136,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-endo-genetics","source_name":"PubMed · 生殖内分泌/遗传/保存","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"本研究系统检索并评价了全球范围内针对0–39岁男性癌症患者生育力保存的临床实践指南，共纳入33部指南，采用AGREE II工具评估质量并分析28个临床与流程要点的推荐一致性。结果显示72%的指南质量评级为“高质量”，但指南间总体一致性仅25%，在伦理与流程领域完全不一致。共识要点包括：以精子冷冻保存为保存方式、在性腺毒性治疗前启动、团队中应包含肿瘤科与生育专科医师；分歧集中于多学科团队构成、青春期前处理及伦理/流程细节。作者认为现有指南不够一致且规定不完整，限制了临床可用性，亟需推动流程与伦理框架的标准化。","summary":"PURPOSE: Advances in child, adolescent and young adult oncology have shifted the focus of cancer treatment towards quality of life. Gonadotoxicity remains a devastating late effect of treatment for some survivors. While numerous guidelines exist for fertility preservation, referral rates for fertility preservation are low. We sought to recognize and understand systemic barriers to standardized fertility care for male child, adolescent and young adults with cancer. MATERIALS AND METHODS: We performed a systematic review and database search of clinical practice guidelines. Eligible guidelines included male children, adolescents, and young adults between the ages of 0-39 years diagnosed with any cancer. Appraisal was performed using the AGREE II instrument. Concordance across 28 clinical and logistical areas was analyzed to identify areas of consensus and disagreement. RESULTS: We identified 33 guidelines globally that met inclusion criteria. Seventy-two percent of appraised guidelines were rated as \"high quality\". Concordance across guidelines was low overall (25%), with complete discordance in ethical and logistical domains. Key consensus items included sperm cryopreservation as a preservation method, initiation prior to gonadotoxic treatment, and inclusion of an oncologist and fertility specialist on the care team. Guidelines disagreed on the specific makeup of a multidisciplinary care team, pre-pubertal treatments, and specific ethical/logistical aspects. CONCLUSIONS: Although guidance for fertility preservation exists, it remains inconsistent and incompletely specified, particularly on ethical and logistical domains, thus limiting its clinical utility. Global efforts must prioritize standardization of logistical and ethical frameworks to enable implementation in real-world clinical practice and accelerate research in areas of controversy.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}