Changes in markers of ovarian reserve and endocrine function in young women with breast cancer undergoing adjuvant chemotherapy.
Changes in markers of ovarian reserve and endocrine function in young women with breast cancer undergoing adjuvant chemotherapy.
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DOI：
10.1002/cncr.25037
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发表时间：
2010-05-01
期刊：
影响因子：
6.2
通讯作者：
Hershman, Dawn L.
中科院分区：
文献类型：
--
作者：
Yu, Bo;Douglas, Nataki;Ferin, Michel J.;Nakhuda, Gary S.;Crew, Katherine;Lobo, Rogerio A.;Hershman, Dawn L.
接受化疗的绝经前妇女有闭经和生育能力受损的风险。我们的目的是评估接受化疗的女性苗勒氏管抑制物质 (MIS)、雌二醇 (E2)、卵泡刺激素 (FSH) 的水平和月经状况。我们对年龄 <40 岁、接受辅助化疗的乳腺癌 (BC) 女性 (n=26) 进行了一项巢式前瞻性队列研究。在化疗前（基线）以及第 6、12、36 和 52 周测量血清 MIS、FSH 和 E2。对照是 134 名年龄匹配且已知生育能力的女性。在基线时比较病例和对照之间的激素水平。使用非参数 Wilcoxon 双样本检验（使用 0.05 的两侧 alpha）测试闭经和年龄亚组之间的差异。患有 BC 的受试者和年龄匹配的对照者具有相似的基线 MIS 水平（中位数 0.94 与 0.86 ng/ml，p>0.05）。血清 MIS 在 6 周时显着下降，并在 52 周内保持抑制状态。化疗期间 E2 水平下降，FSH 水平升高，但在 52 周时，水平恢复到基线。 52 周时，只有 1 名患者的 MIS 高于正常范围下限，15 名患者恢复了月经功能，11 名患者的 FSH 达到绝经前水平，13 名患者的卵泡期 E2 水平。在<35岁的女性中，25%仍然闭经，而在35岁以上的女性中，50%仍然闭经。闭经和经期女性在基线和随访时具有相似的 MIS 值。在患有 BC 的年轻女性中，化疗可快速且显着地降低 MIS。 MIS 的快速减少并不能预测随后的月经功能。化疗可能对卵巢储备功能和内分泌功能产生不同的影响。
Premenopausal women undergoing chemotherapy are at risk for amenorrhea and impaired fertility. Our objective was to assess levels of Mullerian Inhibitory Substance (MIS), Estrodiol(E2), Follicle Stimulating Hormone(FSH) and menstrual status, in women undergoing chemotherapy. We conducted a nested prospective cohort study in women aged <40 years with breast cancer (BC) undergoing adjuvant chemotherapy (n=26). Serum MIS, FSH, and E2 were measured before chemotherapy (baseline) and at weeks 6, 12, 36 and 52. Controls were 134 age-matched women with known fertility. Hormone levels were compared between the cases and controls at baseline. Differences between amenorrhea and age subgroups were tested with the non-parametric Wilcoxon two-sample test using a two-sided alpha of 0.05. Subjects with BC and age-matched controls had similar baseline MIS levels (median 0.94 vs. 0.86 ng/ml, p>0.05). Serum MIS decreased significantly at 6 weeks and remained suppressed for 52 weeks. E2 levels decreased, and FSH levels increased during chemotherapy, however, at 52 weeks, the levels returned to baseline. At 52 weeks, only1 patient had MIS above the lower normal range, 15 had return of menstrual function, 11 had premenopausal levels of FSH, and 13 had follicular phase levels of E2. In women <35, 25% remained amenorrheic, whereas in women over 35, 50% were amenorrheic. Amenorrheic and menstruating women had similar MIS values at baseline and follow-up. In young women with BC, chemotherapy decreases MIS rapidly and dramatically. Rapid reductions in MIS do not predict subsequent menstrual function. Ovarian reserve and endocrine function may be affected differently by chemotherapy.
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