Incidence and Predictive Factors for Recovery of Ovarian Function in Amenorrheic Women in Their 40s Treated With Letrozole
Incidence and Predictive Factors for Recovery of Ovarian Function in Amenorrheic Women in Their 40s Treated With Letrozole
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DOI：
10.1200/jco.2015.62.2985
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发表时间：
2016-05-10
影响因子：
45.3
通讯作者：
O'Shaughnessy, Joyce
中科院分区：
文献类型：
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作者：
Krekow, Lea K.;Hellerstedt, Beth A.;O'Shaughnessy, Joyce
目的
这项前瞻性研究评估了2年芳香化酶抑制剂（AI）治疗对40 - 49岁雌激素受体阳性乳腺癌女性卵巢功能恢复（OFR）发生率的影响，这些女性在诊断时处于绝经前状态，且在辅助治疗期间因化疗导致闭经。
患者与方法
40 - 49岁雌激素受体阳性乳腺癌女性，在以环磷酰胺为基础的辅助化疗后停经，有绝经后血清雌二醇（E2）水平，且接受他莫昔芬治疗≥1年，接受来曲唑（2.5mg）每日治疗≥2年。在基线及2年期间测量血清促卵泡激素（FSH）和E2。采用一般线性模型通过OFR评估系列FSH。采用逻辑回归评估基线预测因素和OFR。
结果
该研究纳入177名女性（145名45 - 49岁女性和32名40 - 44岁女性）。在173名可评估患者中，67名（39%；95%置信区间，31% - 46%）恢复卵巢功能；其中11名患者（6%；95%置信区间，3% - 10%）恢复月经，56名患者（32%；95%置信区间，25% - 39%）出现绝经前E2水平但无月经。在未使用过AI的患者中，系列FSH随时间显著升高（P <.001），OFR状态对其无显著影响（P =.55），但对于恢复月经的患者在第12个月后有轻度下降迹象（P =.0989）。年龄小于45岁和抑制素B是OFR的重要多变量基线预测因素。
结论
这些结果强调了确定因化疗导致闭经的女性绝经的困难。40多岁闭经女性在AI治疗期间OFR的风险较高，应避免对这些患者使用AI治疗。（C）2016年美国临床肿瘤学会
PurposeThis prospective study assessed the impact of 2 years of aromatase inhibitor (AI) therapy on the incidence of ovarian function recovery (OFR) in women age 40 to 49 with estrogen receptor-positive breast cancer who were premenopausal at diagnosis and who underwent chemotherapy-induced amenorrhea during adjuvant treatment.Patients and MethodsWomen age 40 to 49 with estrogen receptor-positive breast cancer who had ceased menstruating with adjuvant cyclophosphamide-based chemotherapy, had postmenopausal serum estradiol (E2), and had received tamoxifen for >= 1 year were treated with letrozole (2.5 mg) daily for >= 2 years. Serum follicle-stimulating hormone (FSH) and E2 were measured at baseline and over 2 years. Ageneral linear model was used to assess serial FSH by OFR. Logistic regression was used to assess baseline predictors and OFR.ResultsThe study enrolled 177 women (145 women age 45 to 49 years and 32 women age 40 to 44 years). Of 173 evaluable patients, 67 (39%; 95% CI, 31% to 46%) regained ovarian function; 11 of these patients (6%; 95% CI, 3% to 10%) resumed menses, and 56 of these patients (32%; 95% CI, 25% to 39%) developed premenopausal E2 without menses. Among AI-naive patients, serial FSH significantly increased over time (P < .001), did not vary significantly by OFR status (P = .55), but showed mild evidence of a decrease after month 12 for those who resumed menses (P = .0989). Age less than 45 years and inhibin B were significant multivariable baseline predictors of OFR.ConclusionThese results emphasize the challenge in determining definitive menopause in women with chemotherapy-induced amenorrhea. The risk of OFR during treatment with AIs in amenorrheic women in their 40s is high, and AI therapy should be avoided in these patients. (C) 2016 by American Society of Clinical Oncology