Predicting Ovarian Activity in Women Affected by Early Breast Cancer: A Meta-Analysis-Based Nomogram
Predicting Ovarian Activity in Women Affected by Early Breast Cancer: A Meta-Analysis-Based Nomogram
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DOI：
10.1634/theoncologist.2015-0183
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发表时间：
2015-10-01
期刊：
影响因子：
5.8
通讯作者：
Torino, Francesco
中科院分区：
文献类型：
--
作者：
Barnabei, Agnese;Strigari, Lidia;Torino, Francesco
背景资料：评估需要抗癌性激素治疗的绝经前妇女的卵巢储备可以帮助临床医生解决一些具有挑战性的问题，包括治疗结束后未来怀孕的可能性。抗苗勒管激素（AMH）和年龄可以可靠地估计卵巢储备。数量有限的研究已经评估AMH和年龄作为乳腺癌patients.Materials和Methods的细胞毒性化疗后剩余卵巢储备的预测因素：要进行荟萃分析发表的数据关于这一主题，我们搜索的医学文献中使用的关键MeSH术语“闭经/化学诱导”，“卵巢储备”，“抗苗勒管激素/血液”和“乳腺肿瘤/药物治疗。“系统性综述和荟萃分析的首选报告项目”声明指导了检索策略。英国采用国家卫生服务指南提取数据并评估数据质量和有效性。受试者工作特征曲线下的面积（ROC/AUC）分析被用来评估基线AMH和年龄model.Results的预测效用：荟萃分析的数据汇总从选定的研究表明，年龄和血清AMH是可靠的预测治疗后的卵巢活动在乳腺癌患者。重要的是，ROC/AUC分析表明，AMH是年龄小于40岁患者治疗后卵巢活性的更可靠预测因子（0.753; 95%置信区间[CI]：0.602-0.904），而年龄大于40岁患者（0.678; 95% CI：0.491-0.866）。我们生成了一个列线图描述年龄，治疗前AMH血清水平，卵巢活性之间的相关性，在1年后结束chemotherapy.Conclusion：正在进行的验证过程后，建议列线图可以帮助临床医生辨别绝经前妇女需要细胞毒性化疗谁应该被认为是高优先生育力保存咨询和程序。
Background: The assessment of ovarian reserve in premenopausal women requiring anticancer gonadotoxic therapy can help clinicians address some challenging issues, including the probability of future pregnancies after the end of treatment. Anti-Mullerian hormone (AMH) and age can reliably estimate ovarian reserve. A limited number of studies have evaluated AMH and age as predictors of residual ovarian reserve following cytotoxic chemotherapy in breast cancer patients.Materials and Methods:To conduct a meta-analysis of published data on this topic, we searched the medical literature using the key MeSH terms "amenorrhea/chemically induced," "ovarian reserve," "anti-Mullerian hormone/blood," and "breast neoplasms/drug therapy." Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements guided the search strategy. U.K. National Health Service guidelines were used in abstracting data and assessing data quality and validity. Area under the receiver operating characteristic curve (ROC/AUC) analysis was used to evaluate the predictive utility of baseline AMH and age model.Results: The meta-analysis of data pooled from the selected studies showed that both age and serum AMH are reliable predictors of post-treatment ovarian activity in breast cancer patients. Importantly, ROC/AUC analysis indicated AMH was a more reliable predictor of post-treatment ovarian activity in patients aged younger than 40 years (0.753; 95% confidence interval [CI]: 0.602-0.904) compared with those older than 40 years (0.678; 95% CI: 0.491-0.866). We generated a nomogram describing the correlations among age, pretreatment AMH serum levels, and ovarian activity at 1 year from the end of chemotherapy.Conclusion: After the ongoing validation process, the proposed nomogram may help clinicians discern premenopausal women requiring cytotoxic chemotherapy who should be considered high priority for fertility preservation counseling and procedures.