Breast Oncology Program, University of Michigan Comprehensive Cancer Center, Department of Biostatistics, and Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
Oncologist. 2014 Jan;19(1):68-74. doi: 10.1634/theoncologist.2013-0145. Epub 2013 Dec 6.
Reproductive-aged women frequently receive both chemotherapy and endocrine therapy as part of their treatment regimen for early stage hormone receptor-positive breast cancer. Chemotherapy results in transient or permanent 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-Müllerian hormone (AMH) and inhibin B concentrations would predict for ovarian function following chemotherapy.
Pre- and perimenopausal women aged 25-50 years with newly diagnosed breast cancer were enrolled. Subjects underwent phlebotomy for assessment of serum AMH, inhibin B, follicle-stimulating hormone, and estradiol prior to chemotherapy and 1 month and 1 year following completion of treatment. Associations among hormone concentrations, clinical factors, and biochemically assessed ovarian function were assessed.
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 initiation were predictive of increased likelihood of recovery of ovarian function.
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.
作为早期激素受体阳性乳腺癌治疗方案的一部分，育龄妇女经常接受化疗和内分泌治疗。大多数女性在化疗后会出现暂时或永久性卵巢功能衰竭。由于难以确定哪些患者会恢复卵巢功能，这对辅助内分泌治疗决策有影响。我们假设，治疗前血清抗苗勒管激素（AMH）和抑制素 B 浓度可以预测化疗后卵巢功能。
招募了年龄在 25-50 岁之间、新诊断为乳腺癌的绝经前和围绝经期女性。在化疗前和完成治疗后 1 个月和 1 年，对受试者进行采血，以评估血清 AMH、抑制素 B、卵泡刺激素和雌二醇。评估了激素浓度、临床因素与生化评估的卵巢功能之间的关系。
27 名受试者可评估主要终点。中位年龄为 41 岁。20 名受试者（74.1%）在 18 个月内恢复了卵巢功能。在 26 名可评估的化疗前受试者中，有 19 名（73.1%）检测到血清 AMH 浓度。基线时检测到血清 AMH 浓度对恢复卵巢功能的阳性预测值为 94.7%，阴性预测值为 85.7%。单因素分析显示，年龄较小和化疗起始时可检测到血清 AMH 浓度与恢复卵巢功能的可能性增加相关。
化疗前评估血清 AMH 可能有助于预测化疗后卵巢功能。这一发现对接受化疗的绝经前妇女辅助内分泌治疗决策具有重要意义。
