Fréour T, Barrière P, Masson D
Service de médecine et biologie du développement et de la reproduction, Hôpital mère et enfant, CHU de Nantes, 38 boulevard Jean Monnet, 44093 Nantes, France; Faculté de médecine, Université de Nantes, 1 rue Gaston Veil, 44035 Nantes, France; INSERM UMR 1064 - ITUN, CHU de Nantes, 30 boulevard Jean Monnet, 44093 Nantes, France.
Service de médecine et biologie du développement et de la reproduction, Hôpital mère et enfant, CHU de Nantes, 38 boulevard Jean Monnet, 44093 Nantes, France; Faculté de médecine, Université de Nantes, 1 rue Gaston Veil, 44035 Nantes, France; INSERM UMR 1064 - ITUN, CHU de Nantes, 30 boulevard Jean Monnet, 44093 Nantes, France.
Eur J Cancer. 2017 Mar;74:1-8. doi: 10.1016/j.ejca.2016.12.008. Epub 2017 Jan 28.
Long-term consequences of cancer treatments in young women, and especially fertility issues, are gaining attention as survival rates increase. Breast cancer is the most frequent malignancy in women of reproductive age.
The purpose of this review is to describe serum anti-müllerian hormone (AMH) level at diagnosis and its evolution during and after chemotherapy in women of reproductive age treated for breast cancer. Second, the impact of taxanes on AMH, the association between AMH and amenorrhea, and the comparison of AMH with other hormonal markers of ovarian reserve were studied.
A systematic PubMed search was conducted on all articles, published up to April 2016 and related to AMH in women suffering from breast cancer using the following key words: AMH, müllerian-inhibiting substance, ovarian reserve, ovarian function, breast cancer, gonadotoxicity, ovarian toxicity, amenorrhea, chemotherapy, and menopause.
AMH levels rapidly fall down to undetectable levels in most women during chemotherapy and generally persist at very low levels in most women after the treatment. Taxanes seem to impact negatively ovarian function, but data on ovarian reserve are scarce. AMH is a predictor of the occurrence of chemotherapy-related amenorrhea and is the most relevant hormonal marker of ovarian reserve.
Serum AMH is a relevant tool for ovarian reserve assessment and follow-up during treatment in premenopausal women with breast cancer. Further large prospective studies are necessary to determine its predictive interest for post-treatment residual fertility, and eventually use it in fertility preservation counseling before treatment initiation.
随着年轻女性癌症治疗生存率的提高，癌症治疗的长期后果，尤其是生育问题，日益受到关注。乳腺癌是育龄女性中最常见的恶性肿瘤。
本综述的目的是描述乳腺癌育龄女性在诊断时的血清抗苗勒管激素（AMH）水平及其在化疗期间和化疗后的变化。其次，研究紫杉烷类药物对AMH的影响、AMH与闭经之间的关联，以及将AMH与其他卵巢储备激素标志物进行比较。
利用以下关键词对截至2016年4月发表的所有与乳腺癌女性AMH相关的文章进行了系统的PubMed检索：AMH、苗勒管抑制物质、卵巢储备、卵巢功能、乳腺癌、性腺毒性、卵巢毒性、闭经、化疗和绝经。
在化疗期间，大多数女性的AMH水平迅速降至无法检测的水平，并且在治疗后大多数女性的AMH水平通常持续维持在非常低的水平。紫杉烷类药物似乎对卵巢功能有负面影响，但关于卵巢储备的数据较少。AMH是化疗相关闭经发生的预测指标，也是卵巢储备最相关的激素标志物。
血清AMH是评估绝经前乳腺癌女性治疗期间卵巢储备及进行随访的相关工具。需要进一步开展大型前瞻性研究，以确定其对治疗后剩余生育能力的预测价值，并最终在治疗开始前将其用于生育力保存咨询。
