Prediction of Postchemotherapy Ovarian Function UsingMarkers of Ovarian Reserve
Prediction of Postchemotherapy Ovarian Function UsingMarkers of Ovarian Reserve
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DOI：
10.1634/theoncologist.2013-0145
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发表时间：
2014-01-01
期刊：
影响因子：
5.8
通讯作者：
Hayes, Daniel F.
中科院分区：
文献类型：
--
作者：
Henry, N. Lynn;Xia, Rong;Hayes, Daniel F.
背景。处于生育年龄的女性在早期激素受体阳性乳腺癌的治疗方案中经常同时接受化疗和内分泌治疗。化疗导致大多数女性出现暂时性或永久性卵巢功能衰竭。确定哪些患者的卵巢功能会恢复存在困难，这对辅助内分泌治疗决策有影响。我们假设治疗前血清抗苗勒氏管激素（AMH）和抑制素B浓度可预测化疗后的卵巢功能。
方法。招募年龄在25 - 50岁、新诊断为乳腺癌的绝经前和围绝经期女性。受试者在化疗前以及治疗完成后1个月和1年进行静脉采血，以评估血清AMH、抑制素B、卵泡刺激素和雌二醇。评估激素浓度、临床因素和生化评估的卵巢功能之间的关联。
结果。27名受试者可用于主要终点评估。中位年龄为41岁。20名受试者（74.1%）在18个月内卵巢功能恢复。在化疗前评估的26名可评估受试者中，19名（73.1%）血清AMH浓度可检测到。可检测到的基线血清AMH浓度对卵巢功能恢复的阳性预测值为94.7%，阴性预测值为85.7%。单因素分析显示，较年轻的年龄以及化疗开始时可检测到的血清AMH浓度可预测卵巢功能恢复可能性增加。
结论。化疗前评估血清AMH可能有助于预测化疗后的卵巢功能。这一发现对绝经前接受化疗的女性辅助内分泌治疗决策有影响。
Background. Reproductive-aged women frequently receive both chemotherapy and endocrine therapy as part of their treatment regimen for early stage hormone receptor-positive breastcancer. Chemotherapyresults in transient orpermanent ovarian failure in the majority of women. The difficulty in determining which patients will recover ovarian function has implications for adjuvant endocrine therapy decision making. We hypothesized that pretreatment serum anti-Mullerian hormone (AMH) and inhibin B concentrations would predict for ovarian function following chemotherapy.Methods. Pre-and perimenopausal women aged 25-50 years with newly diagnosed breast cancer were enrolled. Subjects underwentphlebotomy for assessment ofserumAMH, inhibinB, follicle-stimulating hormone, and estradiol prior to chemotherapy and 1month and 1 year following completion of treatment. Associations among hormone concentrations, clinical factors, and biochemically assessed ovarian function were assessed.Results. Twenty-seven subjects were evaluable for the primary endpoint. Median age was 41. Twenty subjects (74.1%) experienced recovery of ovarian function within 18 months. Of the 26 evaluable subjects assessed prior to chemotherapy, 19 (73.1%) had detectable serum concentrations of AMH. The positive predictive value of a detectable baseline serum AMH concentration for recovery of ovarian function was 94.7%, and the negative predictive value was 85.7%. On univariate analysis, younger age and detectable serum AMH concentration at chemotherapy initiationwere predictive of increased likelihood of recovery of ovarian function.Conclusion. Prechemotherapy assessment of serum AMH may be useful for predicting postchemotherapy ovarian function. This finding has implications for decision making about adjuvant endocrine therapy in premenopausal women treated with chemotherapy.