Shin Jae Jun, Choi Young Min, Jun Jong Kwan, Lee Kyung-Hun, Kim Tae-Yong, Han Wonshik, Im Seock-Ah
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Fertility Center, Heryoojae Women's Hospital, Goyang, Korea.
J Breast Cancer. 2020 Jun;23(3):268-278. doi: 10.4048/jbc.2020.23.e33.
This study was performed to investigate the effect of the interval between the start of gonadotropin-releasing hormone agonist (GnRHa) and the start of chemotherapy on ovarian protection in patients with breast cancer.
This was a prospective observational cohort study that included 136 patients with breast cancer below 40 years who received GnRHa during chemotherapy for fertility preservation. Plasma anti-Müllerian hormone (AMH) levels were measured before chemotherapy (baseline) and after chemotherapy. Subjects were divided into 3 groups according to the interval between the start of GnRHa and the start of chemotherapy for analysis: 1-6 days, 7-13 days, and ≥ 14 days. The ratio of the post-chemotherapy AMH value to the baseline AMH (pcAMH) at each time point were compared among the 3 groups. Ranked analysis of covariance was used for statistical analysis, adjusted for age, body mass index (BMI), and the existence of polycystic ovaries (PCOs). In addition, recovery of ovarian function (AMH ≥ 1 ng/mL) at 12 months was evaluated.
The median age of the patients was 32 years. There was no difference in the baseline AMH levels among the 3 groups (mean ± standard error: 5.0 ± 0.4 ng/mL [1-6 days], 5.3 ± 0.7 ng/mL [7-13 days], and 8.1 ± 1.3 ng/mL [≥ 14 days]; = 0.250). The pcAMH at 3, 6, 12, 24, and 36 months were not significantly different among the 3 groups (-values were 0.332, 0.732, 0.830, 0.148, and 0.393, respectively). In multivariate analysis, young age ( = 0.024), low BMI ( = 0.013), and the existence of PCO ( = 0.015) were predictors for AMH ≥ 1 ng/mL at 12 months.
There was no difference in the ovarian protective effect according to the difference in the timing of administration of GnRHa.
本研究旨在探讨促性腺激素释放激素激动剂（GnRHa）开始使用与化疗开始之间的时间间隔对乳腺癌患者卵巢保护的影响。
这是一项前瞻性观察队列研究，纳入了136例40岁以下在化疗期间接受GnRHa以保留生育功能的乳腺癌患者。在化疗前（基线）和化疗后测量血浆抗苗勒管激素（AMH）水平。根据GnRHa开始使用与化疗开始之间的时间间隔将受试者分为3组进行分析：1 - 6天、7 - 13天和≥14天。比较3组在每个时间点化疗后AMH值与基线AMH值的比值（pcAMH）。采用协方差秩分析进行统计分析，并对年龄、体重指数（BMI）和多囊卵巢（PCO）的存在情况进行校正。此外，评估12个月时卵巢功能的恢复情况（AMH≥1 ng/mL）。
患者的中位年龄为32岁。3组之间的基线AMH水平无差异（平均值±标准误：5.0±0.4 ng/mL [1 - 6天]，5.3±0.7 ng/mL [7 - 13天]，8.1±1.3 ng/mL [≥14天]；P = 0.250）。3组在3、6、12、24和36个月时的pcAMH无显著差异（P值分别为0.332、0.732、0.830、0.148和0.393）。在多因素分析中，年轻（P = 0.024）、低BMI（P = 0.013）和存在PCO（P = 0.015）是12个月时AMH≥1 ng/mL的预测因素。
根据GnRHa给药时间的差异，卵巢保护效果无差异。
