MRC Centre for Reproductive Health, University of Edinburgh, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK.
Eur J Cancer. 2013 Nov;49(16):3404-11. doi: 10.1016/j.ejca.2013.07.014. Epub 2013 Aug 19.
Improving survival for women with early breast cancer (eBC) requires greater attention to the consequences of treatment, including risk to ovarian function. We have assessed whether biochemical markers of the ovarian reserve might improve prediction of chemotherapy related amenorrhoea.
Women (n=59, mean age 42.6 years [(range 23.3-52.5]) with eBC were recruited before any treatment. Pretreatment ovarian reserve markers (anti-Müllerian hormone [AMH], follicle-stimulating hormone [FSH], inhibin B) were analysed in relation to ovarian status at 2 years.
Pretreatment AMH was significantly lower in women with amenorrhoea at 2 years (4.0 ± 0.9 pmol/L versus 17.2 ± 2.5, P<0.0001), but FSH and inhibin B did not differ between groups. By logistic regression, pretreatment AMH, but not age, FSH or inhibin B, was an independent predictor of ovarian status at 2 years (P=0.005; odds ratio 0.013). We combined these data with a similar cohort (combined n=75); receiver-operator characteristic analysis for AMH gave area under curve (AUC) of 0.90 (95% confidence interval (CI) 0.82-0.97)). A cross-validated classification tree analysis resulted in a binary classification schema with sensitivity 98.2% and specificity 80.0% for correct classification of amenorrhoea.
Pretreatment AMH is a useful predictor of long term post chemotherapy loss of ovarian function in women with eBC, adding significantly to the only previously established individualising predictor, i.e. age. AMH measurement may assist decision-making regarding treatment options and fertility preservation procedures.
提高早期乳腺癌（eBC）女性的生存率需要更加关注治疗的后果，包括对卵巢功能的风险。我们评估了卵巢储备的生化标志物是否可以改善化疗相关闭经的预测。
在任何治疗之前，招募了 59 名患有 eBC 的女性（平均年龄 42.6 岁[范围 23.3-52.5]）。分析了预处理卵巢储备标志物（抗苗勒管激素[AMH]、卵泡刺激素[FSH]、抑制素 B）与 2 年时的卵巢状态之间的关系。
闭经 2 年的女性预处理 AMH 明显较低（4.0±0.9 pmol/L 与 17.2±2.5，P<0.0001），但 FSH 和抑制素 B 在两组之间无差异。通过逻辑回归，预处理 AMH，而不是年龄、FSH 或抑制素 B，是 2 年时卵巢状态的独立预测因素（P=0.005；优势比 0.013）。我们将这些数据与类似的队列（联合 n=75）结合；AMH 的接收器工作特征分析给出曲线下面积（AUC）为 0.90（95%置信区间（CI）0.82-0.97））。交叉验证分类树分析导致了一种二进制分类方案，对于正确分类闭经的敏感性为 98.2%，特异性为 80.0%。
预处理 AMH是 eBC 女性化疗后长期卵巢功能丧失的有用预测指标，显著增加了唯一先前建立的个体化预测指标，即年龄。AMH 测量可能有助于决策治疗选择和生育保护程序。
